Provider Demographics
NPI:1003838483
Name:SIWIK, ERNEST S (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:S
Last Name:SIWIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CHERRY ST STE 2800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2222 CHERRY ST STE 2800
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2675
Practice Address - Country:US
Practice Address - Phone:419-251-8035
Practice Address - Fax:419-251-7716
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2029092080P0202X
OH35-0633712080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000028275OtherANTHEM
OHP00432698OtherRAILROAD MEDICARE
OH000000526129OtherANTHEM
OH364024OtherWELLCARE
OH653716OtherAETNA
OH735431OtherBUCKEYE
OH857729OtherBCMH
OH000000217458OtherUNISON
OH0857729Medicaid
PA0016456360001OtherPA MEDICAID
OHP00131510OtherRAILROAD
PA0016456360001OtherPA MEDICAID
OHP00432698OtherRAILROAD MEDICARE
OHF31325Medicare UPIN