Individual
MARY TERESA SIVIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6701 ROCKSIDE RD, SUITE 330, INDEPENDENCE, OH 44131-2358
(216) 524-4009
(216) 524-7933
Mailing address
6701 ROCKSIDE RD, SUITE 330, INDEPENDENCE, OH 44131-2358
(216) 524-4009
(216) 524-7933
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35069922
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000139991
ANTHEM
OH
05
—
0288031
—
OH
01
—
T69922
SUMMACARE/APEX
OH
Enumeration date
04/25/2006
Last updated
11/09/2007
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