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General NPI Number Information
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NPI Number | 1154595114
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Entity Type | Organization
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Legal Business Name | KAUFMAN MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 1750 BLANKENSHIP RD STE 275
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City | WEST LINN
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State | OR
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Zip | 97068-5101
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Country | US
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Telephone | 503-657-0074
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Fax | 503-657-0295
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Provider Business Mailing Address
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Address Line | 1750 BLANKENSHIP RD STE 275
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City | WEST LINN
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State | OR
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Zip | 97068-5101
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Country | US
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Telephone | 503-657-0074
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Fax | 503-657-0295
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. EVAN MCKECHNIE
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Credential |
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Telephone | 503-657-0074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DO08427
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License Number State | OR
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