Healthcare Provider Details

I. General information

NPI: 1265691380
Provider Name (Legal Business Name): DEREK THIGPIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEALTH PARK BLVD STE D
GRAND BLANC MI
48439-2558
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-603-8400
  • Fax: 810-603-8410
Mailing address:
  • Phone: 810-424-2011
  • Fax: 810-249-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101017639
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: