Provider Demographics
NPI:1770030611
Name:MARSHALL, ERIC (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1849
Mailing Address - Country:US
Mailing Address - Phone:517-205-7069
Mailing Address - Fax:517-205-7047
Practice Address - Street 1:1100 E MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1849
Practice Address - Country:US
Practice Address - Phone:517-205-7069
Practice Address - Fax:517-205-7047
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant