Provider Demographics
NPI:1558451724
Name:MARY MARSHALL, MD, PC
Entity Type:Organization
Organization Name:MARY MARSHALL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-695-2210
Mailing Address - Street 1:8195 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1885
Mailing Address - Country:US
Mailing Address - Phone:810-695-2210
Mailing Address - Fax:810-695-9530
Practice Address - Street 1:8195 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1885
Practice Address - Country:US
Practice Address - Phone:810-695-2210
Practice Address - Fax:810-695-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM070680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0988828OtherHEALTHPLUS PROV #
MI131834OtherPREFERRED CHOICES #
MIP11144157OtherHAP PROV #
MIP11144157OtherMULTIPLAN PROV #
MI080162382OtherRAILROAD MR PROV #
MI0802505112OtherBCBS PROV #
MI104238722Medicaid
MIC7218OtherMCARE PROV #
MIP11144157OtherMULTIPLAN PROV #
MIC7218OtherMCARE PROV #
MIP11144157OtherHAP PROV #