Individual
MARSHAL J. MIRVISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4455
(414) 389-2790
Mailing address
PO BOX 689711, MILWAUKEE, WI 53268-9711
(414) 456-3100
(414) 456-3113
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20062
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30178100
—
WI
Enumeration date
09/08/2005
Last updated
11/05/2020
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