Healthcare Provider Details

I. General information

NPI: 1407097272
Provider Name (Legal Business Name): MARSHALL SHIEH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 SAN DIMAS ST
BAKERSFIELD CA
93301-1605
US

IV. Provider business mailing address

2901 SILLECT AVE STE 201
BAKERSFIELD CA
93308-6373
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-2101
  • Fax:
Mailing address:
  • Phone: 661-327-2101
  • Fax: 661-327-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE4846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: