| Doctor Name: | MICHAEL BRYANT MARCUM |
| NPI Number: | 1679775654 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | VL73038714 |
| Business Practice Address: | 1465 Morris Lane Blue Run Rd # A Lucasville, OH - 456488701 |
| Business Phone Number: | 7402599531 |
| Business Fax Number: | 7402599531 |
| Mailing Address: | 1465 Morris Lane Blue Run Rd # A, LUCASVILLE |
| State: | OH |
| Postal Code: | 456488701 |
| Phone Number: | 7402599531 |
| Fax Number: | 7402599531 |
| NPI Enumeration Date: | 06/03/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | VL73038714 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OH |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |