Provider Demographics
NPI:1508853185
Name:MARSH, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:8501 75TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7602
Practice Address - Country:US
Practice Address - Phone:262-898-4400
Practice Address - Fax:262-764-6157
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111235207N00000X
WI40658-20207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00429348OtherPTAN
ILK47476OtherMEDICARE PTAN
ILK37533Medicare PIN
ILI09226Medicare UPIN
IL215975OtherMEDICARE PTAN