Provider Demographics
NPI:1164407060
Name:KIEFHABER, RAY E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:E
Last Name:KIEFHABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3807
Mailing Address - Country:US
Mailing Address - Phone:513-424-7711
Mailing Address - Fax:513-424-3599
Practice Address - Street 1:275 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3807
Practice Address - Country:US
Practice Address - Phone:513-424-7711
Practice Address - Fax:513-424-3599
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35019649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4676659Medicaid
OH102831Medicare PIN
OHE51823Medicare UPIN