Healthcare Provider Details

I. General information

NPI: 1972574143
Provider Name (Legal Business Name): HARVEY I KAUFMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805B SPRING ST SUITE 120
RACINE WI
53405-1641
US

IV. Provider business mailing address

3805B SPRING ST SUITE 120
RACINE WI
53405-1641
US

V. Phone/Fax

Practice location:
  • Phone: 262-631-8550
  • Fax: 262-631-8557
Mailing address:
  • Phone: 262-631-8550
  • Fax: 262-631-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number45057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: