Provider Demographics
NPI:1790949097
Name:FREE, MARCUS KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:KYLE
Last Name:FREE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2143 DERFLA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9661
Mailing Address - Country:US
Mailing Address - Phone:810-404-2521
Mailing Address - Fax:888-414-4545
Practice Address - Street 1:2143 DERFLA DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9661
Practice Address - Country:US
Practice Address - Phone:888-550-5154
Practice Address - Fax:888-414-4545
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2019-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301093347208600000X, 208D00000X
TXL0799208600000X
TXLO799208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105431333Medicaid
MI105431333Medicaid