MEDICARE: MALAIKA C 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	2085R0202X	Diagnostic Radiology Physician	47791	CO

General Provider Information

NPI Number	:	1215186911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAIKA C THOMPSON MD

Provider Business Mailing Address
First Line	:	1100 CENTRAL PARK DR
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 CENTRAL PARK DR
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8818
Country	:	US
Telephone Number	:	970-875-2604
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	05/18/2020

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