Provider Demographics
NPI:1619368313
Name:RIEFKOHL ORTIZ, ELAINE
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:RIEFKOHL ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:JANICE
Other - Last Name:RIEFKOHL ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3730 TABS DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9562
Mailing Address - Country:US
Mailing Address - Phone:330-563-0618
Mailing Address - Fax:330-563-0604
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-563-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036164232207P00000X
PR31555R282N00000X
OH130887207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31555ROtherLISCENCE
OH0231300Medicaid