Provider Demographics
NPI:1316107196
Name:MARSHO, TIM DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:DANIEL
Last Name:MARSHO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2721
Mailing Address - Country:US
Mailing Address - Phone:414-774-9200
Mailing Address - Fax:414-774-9031
Practice Address - Street 1:8651 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2721
Practice Address - Country:US
Practice Address - Phone:414-774-9200
Practice Address - Fax:414-774-9031
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121303208000000X
WI52955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics