1720145634 NPI number — OLAF PETER KAUFMAN MD

Table of content: OLAF PETER KAUFMAN MD (NPI 1720145634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720145634 NPI number — OLAF PETER KAUFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
OLAF
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720145634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 UNIVERSITY AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-5945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-961-0453
Provider Business Mailing Address Fax Number:
515-961-2714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12368 STRATFORD DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-8162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-226-9810
Provider Business Practice Location Address Fax Number:
515-226-8408
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  34964 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 23324 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 104349 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 52264 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: MD-34964 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ENROLLED , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ENROLLED , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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