Provider Demographics
NPI:1235484429
Name:BUSH, BENJAMIN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:BUSH
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 1:140 COLEMANS XING STE 200
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7080
Mailing Address - Country:US
Mailing Address - Phone:937-578-4300
Mailing Address - Fax:937-578-4311
Practice Address - Street 1:140 COLEMANS XING STE 200
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7080
Practice Address - Country:US
Practice Address - Phone:937-578-4300
Practice Address - Fax:937-578-4311
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132660207Y00000X
OH35.137457207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology