Provider Demographics
NPI:1376531624
Name:DULAN, MICHAEL BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:DULAN
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 1:1000 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8330
Mailing Address - Country:US
Mailing Address - Phone:513-932-7951
Mailing Address - Fax:513-932-9664
Practice Address - Street 1:1000 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8330
Practice Address - Country:US
Practice Address - Phone:513-932-7951
Practice Address - Fax:513-932-9664
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070148D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014215Medicaid
OH10790873OtherCAQH
OHH221410Medicare PIN
OH10790873OtherCAQH
OHG46046Medicare UPIN