Provider Demographics
NPI:1386631083
Name:KAPLAN, GARY S (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1931
Mailing Address - Country:US
Mailing Address - Phone:313-527-6030
Mailing Address - Fax:313-527-3189
Practice Address - Street 1:14608 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1931
Practice Address - Country:US
Practice Address - Phone:313-527-6030
Practice Address - Fax:313-527-3189
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGK000625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480045180OtherRAILROAD MEDICARE
MI1124924Medicaid
4858253530OtherBCBSM
MI5821330OtherBCBSM
0H23403OtherBCBS
480045180OtherRAILROAD MEDICARE
MI5825353Medicare PIN
MI1124924Medicaid
0507600001Medicare NSC