Provider Demographics
NPI:1790905511
Name:KAPLAN, DEBRA ELYSE (PA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ELYSE
Last Name:KAPLAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 WEST DARTMOOR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-539-3819
Mailing Address - Fax:
Practice Address - Street 1:800 S ADAMS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-646-9597
Practice Address - Fax:248-646-4067
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDK003599207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37470Medicare UPIN
N94160001Medicare ID - Type Unspecified