MEDICARE: MICHEAL THOMPSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G56271	CA

General Provider Information

NPI Number	:	1144391293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEAL THOMPSON MD

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	LEMOORE
State	:	CA
Zip	:	93245-0218
Country	:	US
Telephone Number	:	559-904-6908
Fax Number	:

Provider Business Practice Location Address
First Line	:	4023 W BURBANK BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2120
Country	:	US
Telephone Number	:	818-845-0023
Fax Number	:	818-845-0324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/08/2007

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