Mirviss, Marshal J.
Mirviss, Marshal J. is an individual health care provider with primary practice located at 2025 W Oklahoma Ave , Milwaukee WI 53215-4455. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Mirviss, Marshal J. can be contacted via phone (414) 389-2790.Contact Information
Primary practice address
2025 W Oklahoma Ave
Milwaukee WI 53215-4455
Phone: (414) 389-2790
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 20062 | Wisconsin |
Profile Details
| NPI number | 1205820958 |
|---|---|
| LBN Legal business name | Mirviss, Marshal J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 8th, 2005 |
| Last updated | Nov 5th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205820958 | NPPES |
| Wisconsin | MEDICAID | 30178100 |
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