Provider Demographics
NPI:1245320589
Name:MARSHALL, MARY CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1885
Mailing Address - Country:US
Mailing Address - Phone:810-695-2210
Mailing Address - Fax:810-695-9530
Practice Address - Street 1:8195 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1885
Practice Address - Country:US
Practice Address - Phone:810-695-2210
Practice Address - Fax:810-695-9530
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM070680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080162382OtherRAILROAD MR PROVIDER #
MA0988828OtherHEALTHPLUS PROVIDER #
MI104238722Medicaid
MI131834OtherPREFERRED CHOICES #
MIC7218OtherMCARE PROVIDER #
MI383551198OtherTAX ID
MIP11144157OtherMULTIPLAN PROVIDER #
MI0802505112OtherBCBS PROVIDER NUMBER
MIP11144157OtherHAP PROVIDER NUMBER
MIH14889Medicare UPIN
MI0N85540Medicare ID - Type Unspecified