Provider Demographics
NPI:1033286646
Name:GARRICK, MARSHALL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:LOUIS
Last Name:GARRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 BAYTOWNE DR
Mailing Address - Street 2:#14
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7976
Mailing Address - Country:US
Mailing Address - Phone:217-352-2546
Mailing Address - Fax:217-244-1758
Practice Address - Street 1:1109 S LINCOLN AVE
Practice Address - Street 2:3 RD FLOOR
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4703
Practice Address - Country:US
Practice Address - Phone:217-333-2705
Practice Address - Fax:217-244-1758
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36-535602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry