Healthcare Provider Details

I. General information

NPI: 1083146534
Provider Name (Legal Business Name): RYAN MICHAEL KAUFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST UNIT 310
LOUISVILLE KY
40202-5703
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4720
  • Fax: 502-561-8687
Mailing address:
  • Phone: 502-588-4720
  • Fax: 502-461-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTP132
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTP132
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: