Provider Demographics
NPI:1629051792
Name:MARCRUM, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MARCRUM
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 1:8735 STATE ROAD 37 STE B
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-9304
Mailing Address - Country:US
Mailing Address - Phone:812-547-9663
Mailing Address - Fax:812-772-2871
Practice Address - Street 1:8735 STATE ROAD 37 STE B
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-9304
Practice Address - Country:US
Practice Address - Phone:812-547-9663
Practice Address - Fax:812-772-2871
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037688A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100338240BMedicaid
D95719Medicare UPIN
IN164970Medicare PIN