Provider Demographics
NPI: | 1497860167 |
---|---|
Name: | KAPLANIS, PAUL TRAIANOS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PAUL |
Middle Name: | TRAIANOS |
Last Name: | KAPLANIS |
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: | 260-373-9700 |
Mailing Address - Fax: | 260-373-9740 |
Practice Address - Street 1: | 6130 TRIER RD |
Practice Address - Street 2: | |
Practice Address - City: | FORT WAYNE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46815-5339 |
Practice Address - Country: | US |
Practice Address - Phone: | 260-422-2481 |
Practice Address - Fax: | 260-969-3067 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-20 |
Last Update Date: | 2009-10-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01031926A | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 000000595578 | Other | ANTHEM |
IN | 100080210 | Medicaid | |
IN | 080130049 | Other | MEDICARE RR |
IN | 100080210 | Medicaid | |
IN | 259060J | Medicare PIN | |
IN | 055250EE | Medicare ID - Type Unspecified |