Provider Demographics
NPI:1174515381
Name:MARSHALL, JOHN MORGAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MORGAN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1880
Mailing Address - Country:US
Mailing Address - Phone:248-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:25500 MEADOWBROOK RD STE 150
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1880
Practice Address - Country:US
Practice Address - Phone:248-784-3667
Practice Address - Fax:248-869-3982
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102078208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6800025Medicaid
VA6820328Medicaid
TN3059908Medicaid
TN3059909Medicaid
003045657OtherBLUECROSSBLUESHIELD
250002418OtherRAILROAD MEDICARE
621428746-04OtherJOHN DEERE
TN3059909Medicaid
621428746-04OtherJOHN DEERE
VA6820328Medicaid
MI0Q26462080Medicare PIN