Provider Demographics
NPI:1487783155
Name:MARSHBANKS, MATTHEW BRETT (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRETT
Last Name:MARSHBANKS
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 1:1801 ASHLEY CIR
Mailing Address - Street 2:SUITE 535
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3362
Mailing Address - Country:US
Mailing Address - Phone:270-790-5550
Mailing Address - Fax:270-793-5351
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4637
Practice Address - Country:US
Practice Address - Phone:502-895-8911
Practice Address - Fax:502-426-8272
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40819207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000538125OtherANTHEM BCBS
KY00418002Medicare PIN
KYP00622678Medicare PIN