Provider Demographics
NPI:1053316489
Name:KAUFMAN, SUSAN M (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1251 LINCOLN HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7356
Practice Address - Country:US
Practice Address - Phone:419-738-5151
Practice Address - Fax:419-941-1092
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-10-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAOS006866L207Q00000X
OH34010062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1754199OtherSELECTCARE
NY0025215401OtherUNIVERA INSURANCE CO
PA080169885OtherRAILROAD MEDICARE PIN
PA25-1754199OtherINTERGROUP
PA2725313OtherCIGNA
PA0011702840010Medicaid
PA25-1754199OtherUNITED HEALTHCARE
PA303685OtherUPMC HEALTH PLAN
PAKA580453OtherHIGHMARK
PA0011702840011Medicaid
PA0011702840005Medicaid
PA25-1754199OtherDEVON
OH3126316Medicaid
PA25-1754199OtherVANTAGE
PA580453OtherBLUE SHIELD
PA25-1754199OtherHEALTH AMERICA
PAKA580453OtherHIGHMARK
PA25-1754199OtherINTERGROUP
PA580453TEWMedicare PIN
PA2725313OtherCIGNA
OHKA4313511Medicare PIN
PA085112Medicare ID - Type Unspecified