Provider Demographics
NPI:1790745966
Name:MARSH, DOUGLAS LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LAWRENCE
Last Name:MARSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18590 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1516
Mailing Address - Country:US
Mailing Address - Phone:313-928-5000
Mailing Address - Fax:313-928-2215
Practice Address - Street 1:18590 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1516
Practice Address - Country:US
Practice Address - Phone:313-928-5000
Practice Address - Fax:313-928-2215
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007923207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101007923OtherSTATE LICENSE
MIAM1081025OtherDEA
MIXM1081025OtherDEA
MI5101007923OtherSTATE LICENSE