Healthcare Provider Details

I. General information

NPI: 1952384372
Provider Name (Legal Business Name): ANGELA KAY THOMPSON-BUSCH M.D.,PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA KAY THOMPSON M.D.,PH.D

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BARCLAY AVE NE SUITE 300
GRAND RAPIDS MI
49503-2556
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-8100
  • Fax: 616-391-8897
Mailing address:
  • Phone: 616-391-8100
  • Fax: 616-391-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41746
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: