Dr.Keith N Marshall PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

5101007974 Issued in MI

Legal business name

DR.KEITH N MARSHALL PLLC

Practice address

3272 E 12 Mile Rd
Suite 102
Warren, MI 48092-5622

Phone

(586) 558-9360

Fax

(586) 573-3130

NPI assigned

Feb 12, 2007

Last updated

Dec 5, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keith N Marshall, D.ONPI 1578655049

Title

Ceo

Phone

(586) 558-9360

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith N Marshall, D.O.

  • Surgery Physician
  • Warren, MI
  • NPI 1578655049
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1538200415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3272 E 12 MILE RD",
            "address_2": "SUITE 102",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925622",
            "telephone_number": "586-558-9360",
            "fax_number": "586-573-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3272 E 12 MILE RD",
            "address_2": "SUITE 102",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925622",
            "telephone_number": "586-558-9360",
            "fax_number": "586-573-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR.KEITH N MARSHALL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-558-9360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101007974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4508283",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Warren, MI
• Providers in Warren, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.