Provider Demographics
NPI:1447278528
Name:UELTSCHEY, MARCUS E (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:E
Last Name:UELTSCHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TURNER PARK DR
Mailing Address - Street 2:P. O. BOX 1389
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-9214
Mailing Address - Country:US
Mailing Address - Phone:662-869-2122
Mailing Address - Fax:662-869-1367
Practice Address - Street 1:125 TURNER PARK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9214
Practice Address - Country:US
Practice Address - Phone:662-869-2122
Practice Address - Fax:662-869-1367
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015894Medicaid
MS425198310AOtherP JONES BLUE CROSS
LA1785601Medicaid
MS5153241OtherP JONES AETNA
MS3191589OtherP JONES CIGNA
MS00015920Medicaid
MS00125653Medicaid
MS7813397OtherAETNA
MS09015894Medicaid
MS00125653Medicaid
LA1785601Medicaid
MS3191589OtherP JONES CIGNA
MSH40783Medicare UPIN
MS100000144Medicare ID - Type Unspecified