Healthcare Provider Details

I. General information

NPI: 1629249990
Provider Name (Legal Business Name): PAMELA THOMPSON DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 CHARLAR DR
HOLT MI
48842-6804
US

IV. Provider business mailing address

4221 CHARLAR DR
HOLT MI
48842-6804
US

V. Phone/Fax

Practice location:
  • Phone: 517-694-7600
  • Fax: 517-694-7003
Mailing address:
  • Phone: 517-694-7600
  • Fax: 517-694-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009580
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005021
License Number StateMI

VIII. Authorized Official

Name: DR. PAMELA THOMPSON
Title or Position: MEMBER
Credential: DO
Phone: 517-694-7600