Basic Information
| Provider Information | |||||||||
| NPI: | 1104863786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 STATE ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 6169131818 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 STATE ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169131808 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301057219 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3414825 | 05 | MI | MEDICAID | 4753109 | 05 | MI | MEDICAID | 4753118 | 05 | MI | MEDICAID | 2995002 | 05 | MI | MEDICAID | 4181871 | 05 | MI | MEDICAID | 4181826 | 05 | MI | MEDICAID | 4753127 | 05 | MI | MEDICAID | 4753154 | 05 | MI | MEDICAID | 4878373 | 05 | MI | MEDICAID | 4878041 | 05 | MI | MEDICAID | 4382136 | 05 | MI | MEDICAID | 4753083 | 05 | MI | MEDICAID | 4753145 | 05 | MI | MEDICAID | 4753136 | 05 | MI | MEDICAID |