MEDICARE: SIAMAK GHANBARI ROSTAMABADI MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.093900	OH
2	207R00000X	Internal Medicine Physician	48820	KY
3	208M00000X	Hospitalist Physician	35.093900	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1588801757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIAMAK GHANBARI ROSTAMABADI MD

Provider Business Mailing Address
First Line	:	30 E APPLE ST STE 6250
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2939
Country	:	US
Telephone Number	:	937-208-8394
Fax Number	:	937-208-8388

Provider Business Practice Location Address
First Line	:	30 E APPLE ST
Second Line	:	SUITE 6250
City	:	DAYTON
State	:	OH
Zip	:	45409-2939
Country	:	US
Telephone Number	:	937-208-8394
Fax Number	:	937-208-8388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	04/07/2026

30 E APPLE ST STE 5254A
DAYTON, OH
45409-2939

Practice Phone: 937-208-4200
Practice Fax: 937-208-2678

30 E APPLE ST STE 5254A
DAYTON, OH
45409-2939