Healthcare Provider Details

I. General information

NPI: 1427040914
Provider Name (Legal Business Name): MARK D BEJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 HOAG DR SUITE 111
SHEFFIELD VILLAGE OH
44035-1494
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-2272
  • Fax:
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35063592
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: