Basic Information
| Provider Information | |||||||||
| NPI: | 1992143028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 744 S WEBSTER AVE | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543013505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204457222 | ||||||||
| FaxNumber: | 9204457289 | ||||||||
| Practice Location | |||||||||
| Address1: | 5450 FORT ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481834601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346713297 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 67219-21 | WI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5101020695 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.