Provider Demographics
NPI:1447574033
Name:GERALD KAPLAN, MD SC
Entity Type:Organization
Organization Name:GERALD KAPLAN, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-296-3030
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5190
Mailing Address - Country:US
Mailing Address - Phone:773-296-3030
Mailing Address - Fax:773-296-3033
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5190
Practice Address - Country:US
Practice Address - Phone:773-296-3030
Practice Address - Fax:773-296-3033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERALD KAPLAN, MD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-25
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040717208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040717Medicaid
458810Medicare PIN
IL036040717Medicaid