Provider Demographics
NPI:1912993486
Name:RIEFKOHL, GLORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:RIEFKOHL
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 1:3200 SW 62 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-8080
Mailing Address - Country:US
Mailing Address - Phone:305-669-6505
Mailing Address - Fax:305-669-6447
Practice Address - Street 1:3200 SW 62 AVENUE
Practice Address - Street 2:MCH PEDIATRIC CARE CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-669-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46871Medicare UPIN