Provider Demographics
NPI:1134179963
Name:JAMES, MARSHALL EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:EDWARD
Last Name:JAMES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3229 BROADWAY STE 205
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-1038
Mailing Address - Country:US
Mailing Address - Phone:219-806-3000
Mailing Address - Fax:219-806-3024
Practice Address - Street 1:20180 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3153
Practice Address - Country:US
Practice Address - Phone:815-464-2010
Practice Address - Fax:815-464-2181
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103915208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103915Medicaid
IL036103915Medicaid
H50196Medicare UPIN