Healthcare Provider Details

I. General information

NPI: 1710906029
Provider Name (Legal Business Name): MICHELLE E THOMPSON MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33415-7469
US

IV. Provider business mailing address

4623 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33415-7469
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-8888
  • Fax: 561-641-8303
Mailing address:
  • Phone: 561-967-8888
  • Fax: 561-641-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA32966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: