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Organization
MARSHALL MEDLEY, D.O., P.C.
Active
Organization
MARSHALL MEDLEY, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHALL KEVIN MEDLEY D.O. (OWNER)
(734) 421-1000
Entity
Organization
Contact information
Practice address
35600 CENTRAL CITY PKWY, SUITE 101, WESTLAND, MI 48185-2046
(734) 421-1000
(734) 421-1001
Mailing address
35600 CENTRAL CITY PKWY, SUITE 101, WESTLAND, MI 48185-2046
(734) 421-1000
(734) 421-1001
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
5101013769
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007367710
AETNA
MI
01
—
12192
CAPE HEALTH PLAN
MI
01
—
17178
MCARE
MI
01
—
450851
GREAT LAKES
MI
05
—
4774341
—
MI
01
—
5821256
BCBS
MI
01
—
P36227-F
BCN
MI
01
—
U92085
PHCS
MI
Enumeration date
10/24/2007
Last updated
03/26/2015
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