Provider Demographics
NPI:1336121326
Name:KAUFFMAN, RANDI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:LYNN
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 COUNTRY PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2116
Mailing Address - Country:US
Mailing Address - Phone:941-685-7682
Mailing Address - Fax:
Practice Address - Street 1:3662 COUNTRY PLACE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2116
Practice Address - Country:US
Practice Address - Phone:941-685-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00499102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370484000Medicaid
FL370484000Medicaid
FL09224WMedicare ID - Type Unspecified