Provider Demographics
NPI:1912977430
Name:MIN, MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 W DUE WEST AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4431
Mailing Address - Country:US
Mailing Address - Phone:615-868-0600
Mailing Address - Fax:615-868-9544
Practice Address - Street 1:607 W DUE WEST AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4431
Practice Address - Country:US
Practice Address - Phone:615-868-0600
Practice Address - Fax:615-868-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN25812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802837Medicaid
TN3802837Medicaid
TNG28855Medicare UPIN