Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 47961-20 | WI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 47961-20 | WI |
NPI | 1639134398 |
---|---|
Provider Name | Benjamin C Marcus |
First Address | Middleton, WI 53562-5531 |
Second Address | Middleton, WI 53562-5530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 22/01/2021 |