MEDICARE: CHAD R. KAUFFMAN, DO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1215302567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD R. KAUFFMAN, DO, LLC

Provider Business Mailing Address
First Line	:	7615 DEAN RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3635
Country	:	US
Telephone Number	:	317-504-0738
Fax Number	:

Provider Business Practice Location Address
First Line	:	7615 DEAN RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3635
Country	:	US
Telephone Number	:	317-504-0738
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAD RYAN KAUFFMAN
Credential	:	D.O.
Telephone Number	:	317-504-0738

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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