Provider Demographics
NPI:1912053588
Name:KAUFMAN, LORI ELLEN (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:KAUFMAN
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 1:400 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6452
Mailing Address - Country:US
Mailing Address - Phone:256-882-9777
Mailing Address - Fax:256-882-9188
Practice Address - Street 1:400 WHITESPORT DR SW
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6452
Practice Address - Country:US
Practice Address - Phone:256-882-9777
Practice Address - Fax:256-882-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14161OtherLICENSE
AL63-1174000OtherTAX ID
AL81959OtherBLUE CROSS BLUE SHIELD
AL4113939OtherAETNA
AL63-1174000OtherTAX ID
ALC72458Medicare UPIN