Individual
BRUCE ALLEN MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 622-4693
(217) 788-5556
Mailing address
6450 RELIABLE PARKWAY, CHICAGO, IL 60686
(217) 788-3000
(217) 788-5577
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036102654
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011112
HEALTH ALLIANCE
IL
01
—
020102500
BLACK LUNG
IL
05
—
036102654
—
IL
01
—
08415043
IL BLUE CROSS BLUE SHIELD
IL
01
—
133101600
ACS
IL
01
—
14D0435736
CLIA
IL
01
—
220028805
RR MEDICARE
IL
01
—
32017
PERSONAL CARE ID
IL
01
—
684895
HEALTHLINK
IL
01
—
C12333
RR MEDICARE GROUP
IL
Enumeration date
08/16/2006
Last updated
04/04/2023
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