Healthcare Provider Details

I. General information

NPI: 1053316489
Provider Name (Legal Business Name): SUSAN M KAUFMAN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1251 LINCOLN HWY SUITE 1
WAPAKONETA OH
45895-7356
US

IV. Provider business mailing address

951 COMMERCE PKWY SUITE 101
LIMA OH
45804-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-5151
  • Fax: 419-941-1092
Mailing address:
  • Phone: 419-998-4575
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006866L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34010062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: