Healthcare Provider Details

I. General information

NPI: 1730986704
Provider Name (Legal Business Name): JAMES R THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD
DETROIT MI
48238-3710
US

IV. Provider business mailing address

11656 YOSEMITE ST
DETROIT MI
48204-1430
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-7601
  • Fax:
Mailing address:
  • Phone: 313-425-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: