Individual
SIVA AMBALAVANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 LINCOLN PARK BLVD, SUITE 100, KETTERING, OH 45429-6410
(937) 222-3118
(937) 222-1436
Mailing address
500 LINCOLN PARK BLVD, SUITE 100, KETTERING, OH 45429-6410
(937) 222-3118
(937) 222-1436
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
74675
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000035826
ANTHEM
—
05
—
2102905
—
OH
01
—
2204490
AETNA
—
01
—
310821503030
CARE SOURCE
—
01
—
3108215037C16
UNITED MINE WORKERS
—
01
—
390005871
MEDICARE RAILROAD
—
01
—
D74675
HUMANA
—
Enumeration date
11/14/2005
Last updated
12/19/2024
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