Individual
DR. MARSHALL KEVIN MEDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
35600 CENTRAL CITY PKWY, SUITE 101, WESTLAND, MI 48185-2046
(734) 421-1000
(734) 421-1001
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
5101013769
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012192
CAPE HEALTH PLAN
MI
01
—
0007367710
AETNA
MI
01
—
141412
CARE CHOICES
MI
01
—
17178
MCARE
MI
05
—
4774341
—
MI
01
—
5821256
BLUE CROSS BLUE SHIELD
MI
01
—
P36227-F
BLUE CARE NETWORK
MI
01
—
U92085
PRIVATE HEALTH CARE SYSTE
MI
Enumeration date
09/25/2006
Last updated
11/17/2020
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