1417907981 NPI number — STEVEN L KAUFMAN, MD, PHD, PC

Table of content: (NPI 1417907981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417907981 NPI number — STEVEN L KAUFMAN, MD, PHD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN L KAUFMAN, MD, PHD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417907981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1629 BLUE SPRUCE DR
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-5415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-498-8346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
BLDG G, STE 4
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-498-8346
Provider Business Practice Location Address Fax Number:
970-419-8346
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-498-8346

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  39970 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KAK65432 . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 87407345 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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