Provider Demographics
NPI:1821059288
Name:PLOTKA, MARSHALL BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:BRIAN
Last Name:PLOTKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105B BAILEY CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2797
Mailing Address - Country:US
Mailing Address - Phone:256-882-7469
Mailing Address - Fax:256-425-0046
Practice Address - Street 1:7105B BAILEY CREEK CIR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2797
Practice Address - Country:US
Practice Address - Phone:256-882-7469
Practice Address - Fax:256-425-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10607207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051514602Medicare ID - Type Unspecified
C70324Medicare UPIN