Individual
MARSHALL JAMES CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01075036A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000939535
ANTHEM PROVIDER NUMBER
IN
05
—
201283840
—
IN
Enumeration date
03/26/2012
Last updated
02/01/2021
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