Provider Demographics
NPI:1497757009
Name:KAUFMAN, ALLEN R (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:R
Last Name:KAUFMAN
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 1:1370 NW 114TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7030
Mailing Address - Country:US
Mailing Address - Phone:515-457-7716
Mailing Address - Fax:515-457-7865
Practice Address - Street 1:1370 NW 114TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7030
Practice Address - Country:US
Practice Address - Phone:515-457-7716
Practice Address - Fax:515-457-7865
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25427207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1039347Medicaid
A03002Medicare UPIN
IA1039347Medicaid