Provider Demographics
NPI:1164468534
Name:MARVINNY, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:MARVINNY
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 1:280 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1552
Mailing Address - Country:US
Mailing Address - Phone:541-201-4000
Mailing Address - Fax:
Practice Address - Street 1:280 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1552
Practice Address - Country:US
Practice Address - Phone:541-201-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1352208M00000X
ORDO26701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136209OtherMEDICARE-TYPE UNSPECIFIED
ORP00400668OtherRAIL ROAD MEDICARE
OR005953Medicaid
OR844477040OtherBCBS-GRANTS PASS
OR838366032OtherBCBS-MCMINNVILLE
OR858464039OtherBCBS-SPRINGFIELD
OR838334034OtherBCBS-ROSEBURG
OR858463034OtherBCBS-MEDFORD
OR157875Medicare UPIN
OR136208Medicare PIN
OR844477040OtherBCBS-GRANTS PASS