Provider Demographics
NPI:1174743389
Name:KAUFMAN, DIANA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KAY
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SW ORALABOR RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7004
Mailing Address - Country:US
Mailing Address - Phone:515-963-4400
Mailing Address - Fax:515-964-9838
Practice Address - Street 1:909 SW ORALABOR RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7004
Practice Address - Country:US
Practice Address - Phone:515-963-4400
Practice Address - Fax:515-964-9838
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5194207VG0400X, 207VX0000X
IA38807207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174743389Medicaid
IA719260100Medicare PIN