Individual
TOM IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2123 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 651-1180
(513) 651-2175
Mailing address
4380 MALSBARY RD, SUITE 200, CINCINNATI, OH 45242-5644
(513) 366-4488
(513) 366-4480
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35057125
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000218059
ANTHEM
—
05
—
0706696
—
OH
01
—
1800392
UHNITED
—
01
—
2685094
AETNA
—
01
—
285277
AMERIGROUP
—
01
—
311438871035
CARESOURCE
—
01
—
5712508
HUMANA CHOICECARE
—
05
—
64860414
—
KY
Enumeration date
03/01/2006
Last updated
12/20/2007
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