Provider Demographics
NPI:1659308146
Name:MARSHALL, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MI
Mailing Address - Zip Code:48742-0279
Mailing Address - Country:US
Mailing Address - Phone:989-736-3020
Mailing Address - Fax:989-736-8278
Practice Address - Street 1:177 N BARLOW RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48740-9607
Practice Address - Country:US
Practice Address - Phone:989-736-8157
Practice Address - Fax:989-358-3762
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1647766Medicaid
MI2888254Medicaid
MI2888254Medicaid
MI1647766Medicaid