Individual
THOMAS R MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6820 PARKDALE PL, STE 100, INDIANAPOLIS, IN 46254-6601
(317) 297-7773
(317) 297-3619
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01032356A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200040630
—
IN
Enumeration date
05/22/2006
Last updated
01/14/2021
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