Provider Demographics
NPI:1871183905
Name:KAUFMAN, CHRIS SCOTT (HIS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:SCOTT
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 LAVENDER PKWY STE 1302901
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5085
Mailing Address - Country:US
Mailing Address - Phone:507-333-3932
Mailing Address - Fax:
Practice Address - Street 1:2901 LAVENDER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5087
Practice Address - Country:US
Practice Address - Phone:507-333-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist