Provider Demographics
NPI:1063775542
Name:CHANCE T. KAPLAN, PA
Entity type:Organization
Organization Name:CHANCE T. KAPLAN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-1069
Mailing Address - Street 1:1754 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5721
Mailing Address - Country:US
Mailing Address - Phone:803-807-2844
Mailing Address - Fax:803-548-6994
Practice Address - Street 1:1754 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-5721
Practice Address - Country:US
Practice Address - Phone:803-807-2844
Practice Address - Fax:803-548-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61314261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253692700Medicaid
42283Medicare PIN