Provider Demographics
NPI:1609867043
Name:CYRLIN, MARSHALL N (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:N
Last Name:CYRLIN
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 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-594-6702
Mailing Address - Fax:248-594-6738
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:STE 005
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-594-6702
Practice Address - Fax:248-594-6738
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1439861Medicaid
A67254Medicare UPIN
M90800002Medicare ID - Type Unspecified