Basic Information
| Provider Information | |||||||||
| NPI: | 1063415370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUTTMANN | ||||||||
| FirstName: | AMBROSE | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 READING RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137213200 | ||||||||
| FaxNumber: | 5136393186 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 MERCY HEALTH BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452111104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134815100 | ||||||||
| FaxNumber: | 5134813880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35055531 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 990281 | 01 | OH | AETNA | OTHER | 0700245 | 05 | OH | MEDICAID | 288099 | 01 | OH | AMERIGROUP | OTHER | 0701210 | 01 | OH | UNITED HEALTHCARE | OTHER | 3115705132 | 01 | OH | CARESOURCE | OTHER | 000000021169 | 01 | OH | ANTHEM | OTHER | 160039065 | 01 | OH | MEDICARE RAILROAD | OTHER | 201146010 | 05 | IN | MEDICAID |