Provider Demographics
NPI:1477639672
Name:MARSH, TIMOTHY ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:MARSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 PROGRESS
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9384
Mailing Address - Country:US
Mailing Address - Phone:989-345-1226
Mailing Address - Fax:989-345-7702
Practice Address - Street 1:2339 PROGRESS
Practice Address - Street 2:SUITE A
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-345-1226
Practice Address - Fax:989-345-7702
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM102387208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06093Medicare UPIN
0P04290Medicare ID - Type Unspecified