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General NPI Number Information
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NPI Number | 1780683391
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Entity Type | Individual
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Provider Name | MARSHALL BLAKE HAY MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 611 W. PARK ST. RADIOLOGY
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City | URBANA
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State | IL
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Zip | 61801-2530
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Country | US
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Telephone | 217-383-3270
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Fax | 217-383-4116
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Provider Business Mailing Address
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Address Line | 611 W. PARK ST. BWPC
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City | URBANA
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State | IL
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Zip | 61801-2500
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Country | US
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Telephone | 217-383-6792
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301061520
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036130848
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License Number State | IL
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