Healthcare Provider Details

I. General information

NPI: 1407896020
Provider Name (Legal Business Name): LAURA ANN KAUFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA ANN WEINGART MD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE SUITE 101
CHICAGO IL
60622-1797
US

IV. Provider business mailing address

1431 N WESTERN AVE SUITE 101
CHICAGO IL
60622-1797
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-2272
  • Fax: 773-276-2399
Mailing address:
  • Phone: 773-276-2272
  • Fax: 773-276-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-115307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: