Provider Demographics
NPI:1487654091
Name:MARSHALL, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15990 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:410
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-2850
Practice Address - Fax:248-849-5751
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI448574110Medicaid
MIG63043Medicare UPIN
MI448574110Medicaid