Healthcare Provider Details

I. General information

NPI: 1801911466
Provider Name (Legal Business Name): C DENNIS KAUFMAN D. MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WHITTINGTON PKWY SUITE 101
LOUISVILLE KY
40222-4928
US

IV. Provider business mailing address

320 WHITTINGTON PKWY SUITE 101
LOUISVILLE KY
40222-4928
US

V. Phone/Fax

Practice location:
  • Phone: 502-339-4511
  • Fax: 502-339-4513
Mailing address:
  • Phone: 502-339-4511
  • Fax: 502-339-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number#0019
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: