Basic Information
| Provider Information | |||||||||
| NPI: | 1003838483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIWIK | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 CHERRY ST STE 2800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082675 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2222 CHERRY ST STE 2800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192518035 | ||||||||
| FaxNumber: | 4192517716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | MD.202909 | LA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | 35-063371 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 000000028275 | 01 | OH | ANTHEM | OTHER | P00432698 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000526129 | 01 | OH | ANTHEM | OTHER | 364024 | 01 | OH | WELLCARE | OTHER | 653716 | 01 | OH | AETNA | OTHER | 735431 | 01 | OH | BUCKEYE | OTHER | 857729 | 01 | OH | BCMH | OTHER | 000000217458 | 01 | OH | UNISON | OTHER | 0857729 | 05 | OH | MEDICAID | 0016456360001 | 01 | PA | PA MEDICAID | OTHER | P00131510 | 01 | OH | RAILROAD | OTHER |