Provider Demographics
NPI:1669456943
Name:KIEFABER, ROBERT WOODROW (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WOODROW
Last Name:KIEFABER
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 1:1380 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4926
Mailing Address - Country:US
Mailing Address - Phone:937-293-3486
Mailing Address - Fax:937-293-3605
Practice Address - Street 1:1380 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4926
Practice Address - Country:US
Practice Address - Phone:937-293-3486
Practice Address - Fax:937-293-3605
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053102K207RC0000X
OH35053102207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD5310207OtherHUMANA
OH000000039028OtherANTHEM
OH0626700Medicaid
OH2501765OtherUNITED HEALTHCARE
OH060053778OtherRR MEDICARE
OH2154022OtherAETNA
OH0880144Medicare PIN
OH060053778OtherRR MEDICARE
OH2154022OtherAETNA