Provider Demographics
NPI:1790780005
Name:KAPLANSKY, BRYAN DALE (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DALE
Last Name:KAPLANSKY
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 1:3888 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1708
Mailing Address - Country:US
Mailing Address - Phone:260-489-5446
Mailing Address - Fax:260-489-6997
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR STE 110
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1673
Practice Address - Country:US
Practice Address - Phone:260-373-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042880208100000X
OH35.0576382081S0010X
IN01042880A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250013437OtherMEDICARE RAILROAD
IN250013437Medicare PIN
IN189940Medicare PIN
IN250013437OtherMEDICARE RAILROAD
E86584Medicare UPIN
INM400031207Medicare PIN
OHKA4160661Medicare PIN