Provider Demographics
NPI:1164837233
Name:IMBER, ANN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:IMBER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 KETTERING BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1948
Mailing Address - Country:US
Mailing Address - Phone:937-293-2133
Mailing Address - Fax:
Practice Address - Street 1:3033 KETTERING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1948
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:855-252-2435
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079028207R00000X
FL20691207R00000X
OH35.139581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine