Healthcare Provider Details

I. General information

NPI: 1891724738
Provider Name (Legal Business Name): SETH I KAUFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTWOOD PL STE 110
BRENTWOOD TN
37027-7554
US

IV. Provider business mailing address

100 N HUMPHREYS BLVD
MEMPHIS TN
38120-2146
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-6152
  • Fax:
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-685-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number17581
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number17581
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number11868
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: