Provider Demographics
NPI:1326011321
Name:MARX, DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MARX
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:W168N11237 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3239
Mailing Address - Country:US
Mailing Address - Phone:262-253-5060
Mailing Address - Fax:
Practice Address - Street 1:W168N11237 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3239
Practice Address - Country:US
Practice Address - Phone:262-253-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV30096200Medicaid
WIH12476Medicare UPIN
WIH12476Medicare UPIN