Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 7501002554 | MI |
NPI | 1558879163 |
---|---|
Provider Name | Lisa Anne Kaplan |
First Address | Kalamazoo, MI 49008-2300 |
Second Address | Kalamazoo, MI 49008-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 17/01/2018 |