Healthcare Provider Details

I. General information

NPI: 1740244169
Provider Name (Legal Business Name): PAMELA THOMPSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA THOMPSON ROBERTS

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 CHARLAR DR
HOLT MI
48842
US

IV. Provider business mailing address

4221 CHARLAR DR
HOLT MI
48842
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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: