Healthcare Provider Details

I. General information

NPI: 1265162879
Provider Name (Legal Business Name): MARA ISABELLA KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST STE 9-900
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

420 E SUPERIOR ST STE 9-900
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036180554
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036180554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: