Provider Demographics
NPI:1689952772
Name:MARSHALL, KENNETH EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWIN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:150 FRANKFORT RD STE 103
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-7401
Practice Address - Country:US
Practice Address - Phone:502-844-2888
Practice Address - Fax:502-943-6503
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01070385A207Q00000X, 207R00000X
TN037919207Q00000X
KY26236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine