Provider Demographics
NPI:1659378123
Name:KACHMANN, JEFFREY K (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:KACHMANN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 E UNIVERSITY DR # 30-276
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3645
Mailing Address - Country:US
Mailing Address - Phone:469-557-5434
Mailing Address - Fax:
Practice Address - Street 1:2381 E UNIVERSITY DR STE 50
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2390
Practice Address - Country:US
Practice Address - Phone:469-557-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2384207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN140004182OtherRR MEDICARE
MI4657111Medicaid
OH0278739Medicaid
IN200085300Medicaid
IN5506830003Medicare NSC
OH0821242Medicare PIN
OH0278739Medicaid
IN140004182Medicare PIN
IN140004182OtherRR MEDICARE
IN5506830001Medicare NSC
IN132000BMedicare PIN
OH0821245Medicare PIN