Basic Information
| Provider Information | |||||||||
| NPI: | 1053316489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 COMMERCE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
| FaxNumber: | 4199984586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 LINCOLN HWY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WAPAKONETA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458957356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197385151 | ||||||||
| FaxNumber: | 4199411092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/17/2006 | ||||||||
| NPIReactivationDate: | 03/27/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS006866L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34010062 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 25-1754199 | 01 | PA | SELECTCARE | OTHER | 0025215401 | 01 | NY | UNIVERA INSURANCE CO | OTHER | 080169885 | 01 | PA | RAILROAD MEDICARE PIN | OTHER | 25-1754199 | 01 | PA | INTERGROUP | OTHER | 2725313 | 01 | PA | CIGNA | OTHER | 0011702840010 | 05 | PA | MEDICAID | 25-1754199 | 01 | PA | UNITED HEALTHCARE | OTHER | 303685 | 01 | PA | UPMC HEALTH PLAN | OTHER | KA580453 | 01 | PA | HIGHMARK | OTHER | 0011702840011 | 05 | PA | MEDICAID | 0011702840005 | 05 | PA | MEDICAID | 25-1754199 | 01 | PA | DEVON | OTHER | 3126316 | 05 | OH | MEDICAID | 25-1754199 | 01 | PA | VANTAGE | OTHER | 580453 | 01 | PA | BLUE SHIELD | OTHER | 25-1754199 | 01 | PA | HEALTH AMERICA | OTHER |