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General NPI Number Information
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NPI Number | 1699296012
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Entity Type | Individual
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Provider Name | EARL MAC MARSHALL JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1086 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3193
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Country | US
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Telephone | 734-244-5380
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Fax | 734-244-5795
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Provider Business Mailing Address
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Address Line | 1086 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3193
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Country | US
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Telephone | 734-244-5380
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Fax | 734-244-5795
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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 | 4301500770
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License Number State | MI
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