Provider Demographics
NPI:1225020431
Name:STEVEN L KAUFMAN MD PHD PC
Entity Type:Organization
Organization Name:STEVEN L KAUFMAN MD PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:970-498-8346
Mailing Address - Street 1:1136 E STUART ST
Mailing Address - Street 2:SUITE 4102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1195
Mailing Address - Country:US
Mailing Address - Phone:970-498-8346
Mailing Address - Fax:970-419-8346
Practice Address - Street 1:1136 E STUART ST
Practice Address - Street 2:SUITE 4102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-498-8346
Practice Address - Fax:970-419-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39970208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91012088Medicaid
CO04021929Medicaid
KAK65432OtherGROUP ANTHEM BLUE CROSS
654326OtherANTHEM BLUE CROSS
A73074Medicare ID - Type Unspecified
KAK65432OtherGROUP ANTHEM BLUE CROSS