Provider Demographics
NPI:1518979822
Name:MARSHALL, MICHAEL K (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:MARSHALL
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 1:29 SEAWATCH DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2600
Mailing Address - Country:US
Mailing Address - Phone:912-346-4562
Mailing Address - Fax:
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-346-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71714207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146491AMedicaid
KY50011449OtherPASSPORT
KY2746300000OtherPASSPORT ADVANTAGE
KY000000485103OtherANTHEM BLUE PREFERRED
KY64126584Medicaid
KY000000485103OtherANTHEM BLUE PREFERRED
KYP00355500OtherRAILROAD MEDICARE