Healthcare Provider Details

I. General information

NPI: 1851369532
Provider Name (Legal Business Name): WILLIAM EDWARD THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 STONEBRIDGE DR
FLINT MI
48532-5407
US

IV. Provider business mailing address

2313 STONEBRIDGE DR
FLINT MI
48532-5407
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-9410
  • Fax: 810-732-1943
Mailing address:
  • Phone: 810-732-9410
  • Fax: 810-732-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberWT44504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: