Healthcare Provider Details

I. General information

NPI: 1093771743
Provider Name (Legal Business Name): MARSHO FAMILY MEDICAL GROUP, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N TAYLOR DR
SHEBOYGAN WI
53081-1933
US

IV. Provider business mailing address

1703 N TAYLOR DR
SHEBOYGAN WI
53081-1933
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4438
  • Fax: 920-451-3214
Mailing address:
  • Phone: 920-451-5700
  • Fax: 920-451-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS M THOMPSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 920-451-3240