Provider Demographics
NPI:1952413643
Name:MARSHALL, KASSI MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KASSI
Middle Name:MICHELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12579 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-7400
Mailing Address - Country:US
Mailing Address - Phone:606-285-0681
Mailing Address - Fax:606-285-9843
Practice Address - Street 1:1733 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3277
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:859-278-7690
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY42501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710067020Medicaid