Basic Information
| Provider Information | |||||||||
| NPI: | 1659308146 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 279 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487420279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897363020 | ||||||||
| FaxNumber: | 9897368278 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 N BARLOW RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487409607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
| FaxNumber: | 9893583762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301048087 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1647766 | 05 | MI | MEDICAID | 2888254 | 05 | MI | MEDICAID |