Basic Information
| Provider Information | |||||||||
| NPI: | 1083925119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMANN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 N SAINT JOSEPH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NILES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491202203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696870808 | ||||||||
| FaxNumber: | 2696870811 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 N SAINT JOSEPH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NILES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491202203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696870808 | ||||||||
| FaxNumber: | 2696870811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301104869 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.