Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125-056542 | IL |
N | 111NI0900X | Internist | 125-056542 | IL |
N | 207RC0200X | Critical Care Medicine | 036129569 | IL |
Y | 207RP1001X | Pulmonary Disease | 036129569 | IL |
NPI | 1053549121 |
---|---|
Provider Name | Dr. Brent Kaufmann |
First Address | Urbana, IL 61801-2500 |
Second Address | Urbana, IL 61801-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2009 |
Last Update Date | 30/07/2015 |