Healthcare Provider Details

I. General information

NPI: 1942309778
Provider Name (Legal Business Name): KIMBERLY K THOMSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 344
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

26374 NETWORK PL
CHICAGO IL
60673-1263
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3910
  • Fax:
Mailing address:
  • Phone: 906-225-3630
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35088068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: