Provider Demographics
NPI:1164411203
Name:KAPLAN, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9965
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:3439 HOBSON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1617
Practice Address - Country:US
Practice Address - Phone:260-484-2524
Practice Address - Fax:260-482-9539
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022778207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084163OtherBCBS PROVIDER NUMBER
IN2002462001OtherCIGNA PROVIDER NUMBER
IN1000006667OtherRAILROAD MEDICARE
IN100331570Medicaid
IN4047086OtherAETNA PROVIDER NUMBER
OH0356654Medicaid
IN1000006667OtherRAILROAD MEDICARE
IN100331570Medicaid