=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366712945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD I. KAUFMAN & LOUIS R KAUFMAN DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2012
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1525 E 53RD ST STE 734
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60615-4575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-643-6006
-----------------------------------------------------
Fax | 773-643-0278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 E 53RD ST STE 734
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60615-4575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-643-6006
-----------------------------------------------------
Fax | 773-643-0278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNERSHIP
-----------------------------------------------------
Name | DR. LOUIS ROBERT KAUFMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 773-643-6006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019023953
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------