Provider Demographics
NPI:1952312282
Name:KAUFMANN, KRISTINA SUE (DO)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SUE
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:S
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S. ASH
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622
Mailing Address - Country:US
Mailing Address - Phone:417-345-6100
Mailing Address - Fax:417-345-6866
Practice Address - Street 1:2434 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5406
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-423-6621
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine