| Doctor Name: | DR. AJAY REDDIVARI |
| NPI Number: | 1063494086 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 35-06-0503R |
| Business Practice Address: | 1380 E Stroop Rd Kettering, OH - 454294926 |
| Business Phone Number: | 9372944356 |
| Business Fax Number: | 9372972381 |
| Mailing Address: | 1 Prestige Pl, Suite 550 MIAMISBURG |
| State: | OH |
| Postal Code: | 453423794 |
| Phone Number: | 9377522305 |
| Fax Number: | 9375227513 |
| NPI Enumeration Date: | 11/16/2005 |
| NPI Last Update Date: | 05/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | 35-06-0503R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |