Healthcare Provider Details

I. General information

NPI: 1023086618
Provider Name (Legal Business Name): MICHAEL THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 NW BARRY RD
KANSAS CITY MO
64154-2778
US

IV. Provider business mailing address

5830 NW BARRY RD
KANSAS CITY MO
64154-2778
US

V. Phone/Fax

Practice location:
  • Phone: 816-880-6440
  • Fax: 816-880-6740
Mailing address:
  • Phone: 816-880-6440
  • Fax: 816-880-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR8N96
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: