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NPI Code Detail

MEDICARE: CASSIDY KAUFMAN

MEDICARE: CASSIDY KAUFMAN
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
1363A00000XPhysician Assistant10003803AIN

General Provider Information

NPI Number : 1679290373
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY KAUFMAN
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number : 317-621-7584
Fax Number :
Provider Business Practice Location Address
First Line : 7150 CLEARVISTA DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1695
Country : US
Telephone Number : 317-621-6262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2022
Last Update Date : 02/17/2026

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Directions to “ CASSIDY KAUFMAN ” Practice Location

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