Provider Demographics
NPI:1215168745
Name:UHLENHAKE, ELIZABETH E (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:UHLENHAKE
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 1:5298 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-770-4212
Mailing Address - Fax:513-770-4213
Practice Address - Street 1:5298 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9302
Practice Address - Country:US
Practice Address - Phone:513-770-4212
Practice Address - Fax:513-770-4213
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-122560207N00000X, 207ND0900X
CODR.0055881207N00000X, 207ND0900X
OH122560207ND0900X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0209720Medicaid
CO451764YMWAMedicare PIN
OHH376811Medicare PIN
H376810Medicare PIN