Provider Demographics
NPI:1124057658
Name:MURCEK, BENJAMIN W (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:W
Last Name:MURCEK
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BUILDING F
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-626-1331
Practice Address - Fax:419-626-1338
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004392207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH040016135OtherMEDICARE RAILROAD
OH0794930Medicaid
OHE40824Medicare UPIN
OH040016135OtherMEDICARE RAILROAD