| Organization Name: | MARSHALL LIFESTYLE MEDICINE, PSC |
| NPI Number: | 1306240049 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL KITCHEN (CHIEF OPERATING OFFICER) |
| Mailing Address: | 2251 War Admiral Way Suite 125 Lexington |
| State: | KY US |
| Postal Code: | 405092546 |
| Phone Number: | 8596084841 |
| Fax Number: | |
| NPI Enumeration Date: | 10/09/2014 |
| NPI Last Update Date: | 10/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |