Provider Demographics
NPI:1104809847
Name:SULEK, MARK JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:SULEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MARQUIS LN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4110
Mailing Address - Country:US
Mailing Address - Phone:513-225-4984
Mailing Address - Fax:
Practice Address - Street 1:3922 MARQUIS LN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4110
Practice Address - Country:US
Practice Address - Phone:513-225-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005442S2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01419361OtherRR MEDICARE
OH2091892Medicaid
OHH427560Medicare PIN
P01419361OtherRR MEDICARE
OH4303612Medicare PIN
G30811Medicare UPIN
OH2091892Medicaid