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General NPI Number Information
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NPI Number | 1689952772
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Entity Type | Individual
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Provider Name | KENNETH EDWIN MARSHALL MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 150 FRANKFORT RD STE 103
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City | SHELBYVILLE
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State | KY
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Zip | 40065-7401
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Country | US
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Telephone | 502-844-2888
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Fax | 502-943-6503
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01070385A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 037919
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01070385A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26236
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License Number State | KY
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