Healthcare Provider Details

I. General information

NPI: 1184064909
Provider Name (Legal Business Name): CHRISTOPHER LOREN THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MOUNT HOPE AVE
LANSING MI
48910-3207
US

IV. Provider business mailing address

901 E MOUNT HOPE AVE
LANSING MI
48910-3207
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103705
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: