Provider Demographics
NPI:1306942636
Name:KAUFMANN-REED, ELIZABETH E
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:KAUFMANN-REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:KAUFMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16255 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1615
Mailing Address - Country:US
Mailing Address - Phone:708-599-5000
Mailing Address - Fax:
Practice Address - Street 1:16255 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1615
Practice Address - Country:US
Practice Address - Phone:708-599-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000757363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL877470GMedicaid
INK00535Medicare ID - Type Unspecified