Provider Demographics
NPI:1124002738
Name:MARSHALL, STEPHANIE D (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 CONNECTICUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5581
Mailing Address - Country:US
Mailing Address - Phone:192-472-8990
Mailing Address - Fax:219-472-0270
Practice Address - Street 1:8684 CONNECTICUT ST STE A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5581
Practice Address - Country:US
Practice Address - Phone:192-472-8990
Practice Address - Fax:219-472-0270
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099475207RI0011X
IN02001947A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000375757OtherANTHEM PIN
IN200270150Medicaid
IN200270150AMedicaid
INP00278141Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN000000375757OtherANTHEM PIN
ILK20275Medicare PIN
IN406310ZMedicare PIN