Provider Demographics
NPI:1790891265
Name:KAPLAN, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KAPLAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 W LE MOYNE ST
Mailing Address - Street 2:C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1972
Mailing Address - Country:US
Mailing Address - Phone:773-988-7094
Mailing Address - Fax:773-252-8280
Practice Address - Street 1:2036 W LE MOYNE ST
Practice Address - Street 2:C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1972
Practice Address - Country:US
Practice Address - Phone:773-988-7094
Practice Address - Fax:773-252-8280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL256400Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST