Provider Demographics
NPI: | 1821154618 |
---|---|
Name: | KAUFMAN, SETH M (MD MPH) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SETH |
Middle Name: | M |
Last Name: | KAUFMAN |
Suffix: | |
Gender: | M |
Credentials: | MD MPH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 9755 N 90TH ST |
Mailing Address - Street 2: | SUITE A200 |
Mailing Address - City: | SCOTTSDALE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85258-5046 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-621-3313 |
Mailing Address - Fax: | 480-621-3314 |
Practice Address - Street 1: | 9755 N 90TH ST |
Practice Address - Street 2: | SUITE A200 |
Practice Address - City: | SCOTTSDALE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85258-5046 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-621-3313 |
Practice Address - Fax: | 480-621-3314 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-28 |
Last Update Date: | 2008-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 34143 | 2084N0400X, 2084N0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 942905 | Medicaid | |
AZ | I09663 | Medicare UPIN |