Provider Demographics
NPI:1649213380
Name:KAUFFMAN, DWIGHT A (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:A
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 1:120 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-1253
Mailing Address - Country:US
Mailing Address - Phone:419-396-7683
Mailing Address - Fax:419-396-3312
Practice Address - Street 1:120 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1253
Practice Address - Country:US
Practice Address - Phone:419-396-7683
Practice Address - Fax:419-396-3312
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000358042OtherANTHEM BC/BS
OH2431621Medicaid
OHP00216638OtherRAILROAD CARE
OHP00380701OtherRAILROAD CARE
OH000000487045OtherANTHEM BC/BS
B40900Medicare UPIN
OH2431621Medicaid
OH4134713Medicare PIN