Healthcare Provider Details

I. General information

NPI: 1760698971
Provider Name (Legal Business Name): MARSHALL MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 W MICHIGAN AVE
MARSHALL MI
49068-1497
US

IV. Provider business mailing address

1174 W MICHIGAN AVE
MARSHALL MI
49068-1497
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9867
  • Fax: 269-781-9126
Mailing address:
  • Phone: 269-781-9867
  • Fax: 269-781-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MARK Z MACHALKA
Title or Position: OWNER
Credential: M.D.
Phone: 269-781-9867