Provider Demographics
NPI:1447201256
Name:KAUFFMAN, ERICK ROMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:ROMAN
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2474
Mailing Address - Country:US
Mailing Address - Phone:216-321-9548
Mailing Address - Fax:216-901-9958
Practice Address - Street 1:2358 PROFESSOR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4630
Practice Address - Country:US
Practice Address - Phone:216-334-2800
Practice Address - Fax:216-589-0017
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078036K207Q00000X
WAMD00037575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341300581044OtherCARESOURCE
OHF78036OtherAPEX
OH735725OtherBUCKEYE
OH353965OtherWELLCARE
OH000000129991OtherBLUE CROSS BLUE SHIELD
OH7235143OtherAETNA
OHF78036OtherSUMMA
OH2233854Medicaid
OH7235143OtherAETNA
OHF78036OtherAPEX
OHF78036OtherSUMMA