Provider Demographics
NPI:1063415370
Name:PUTTMANN, AMBROSE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:ANTHONY
Last Name:PUTTMANN
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 1:2060 READING RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1454
Mailing Address - Country:US
Mailing Address - Phone:513-721-3200
Mailing Address - Fax:513-639-3186
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1104
Practice Address - Country:US
Practice Address - Phone:513-481-5100
Practice Address - Fax:513-481-3880
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055531207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH990281OtherAETNA
OH0700245Medicaid
OH288099OtherAMERIGROUP
OH0701210OtherUNITED HEALTHCARE
OH3115705132OtherCARESOURCE
OH000000021169OtherANTHEM
OH160039065OtherMEDICARE RAILROAD
IN201146010Medicaid
OH0700245Medicaid
OHPU0615934Medicare PIN
OH000000021169OtherANTHEM
OH0701210OtherUNITED HEALTHCARE