Provider Demographics
NPI:1740246297
Name:MARKUS, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MARKUS
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 1:3145 HAMILTON MASON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8556
Mailing Address - Country:US
Mailing Address - Phone:513-936-2120
Mailing Address - Fax:513-936-2121
Practice Address - Street 1:3145 HAMILTON MASON RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-8556
Practice Address - Country:US
Practice Address - Phone:513-936-2120
Practice Address - Fax:513-936-2121
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051636207R00000X
OH35-051636207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0660922Medicaid
OHP00850224OtherMEDICARE RR
OH0595677Medicare PIN
OH0660922Medicaid
MA0595675Medicare PIN