Provider Demographics
NPI:1700097003
Name:KAUFMANN, KRISTIANA R (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:R
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 FIRESTONE ST APT 23
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3078
Mailing Address - Country:US
Mailing Address - Phone:586-337-7900
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 3R
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-3338
Practice Address - Fax:313-745-2689
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine