Provider Demographics
NPI:1275669418
Name:KAUFFMAN, MICHAEL GLEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GLEN
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MATTISON DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4148
Mailing Address - Country:US
Mailing Address - Phone:978-369-6079
Mailing Address - Fax:978-369-0343
Practice Address - Street 1:326 MATTISON DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4148
Practice Address - Country:US
Practice Address - Phone:978-369-6079
Practice Address - Fax:978-369-0343
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine