Provider Demographics
NPI:1659332450
Name:KAPLAN, MITCHELL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
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 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:
Practice Address - Street 1:3950 KRESGE WAY STE 207
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4637
Practice Address - Country:US
Practice Address - Phone:502-893-0220
Practice Address - Fax:502-893-0563
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37252174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000715533OtherANTHEM BC/BS
KY64049711Medicaid
KY000057307HOtherHUMANA
KY000000715533OtherANTHEM BC/BS
KY64049711Medicaid
KY253908Medicare ID - Type Unspecified
KYP00939734Medicare PIN