Healthcare Provider Details

I. General information

NPI: 1801851753
Provider Name (Legal Business Name): JONATHAN M. KAUFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27790 W HWY 22 STE 22
BARRINGTON IL
60010
US

IV. Provider business mailing address

912 NORTHWEST HIGHWAY SUITE G-7
FOX RIVER GROVE IL
60021
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-6700
  • Fax: 847-381-6828
Mailing address:
  • Phone: 847-381-6700
  • Fax: 847-381-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036074412
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-074412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: