MEDICARE: DR. MICHAEL BARTLETT THOMPSON D.P.M.

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	213E00000X	Podiatrist	343	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000046034	OTHER	WI	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346294097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BARTLETT THOMPSON D.P.M.

Provider Business Mailing Address
First Line	:	3535 30TH AVE
Second Line	:	203
City	:	KENOSHA
State	:	WI
Zip	:	53144-1632
Country	:	US
Telephone Number	:	262-657-6104
Fax Number	:	262-657-6194

Provider Business Practice Location Address
First Line	:	3535 30TH AVE
Second Line	:	203
City	:	KENOSHA
State	:	WI
Zip	:	53144-1632
Country	:	US
Telephone Number	:	262-657-6104
Fax Number	:	262-657-6194

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/05/2008

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Directions to “ DR. MICHAEL BARTLETT THOMPSON D.P.M.” Practice Location

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