Basic Information
| Provider Information | |||||||||
| NPI: | 1497850887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KIMBROUGH-SUGICK | ||||||||
| OtherFirstName: | JESSIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 EAST MEDICAL CENTER DR | ||||||||
| Address2: | 3RD FLOOR TAUBMAN CENTER RECP B | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365582 | ||||||||
| FaxNumber: | 7346156131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 230213 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301076856 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 4301076856 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.