Healthcare Provider Details

I. General information

NPI: 1548277353
Provider Name (Legal Business Name): DIRK R THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DREW AVE SE
MADELIA MN
56062-1841
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 507-642-5200
  • Fax:
Mailing address:
  • Phone: 407-533-6837
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47119
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019003502
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: