Provider Demographics
NPI:1043353477
Name:THOMPSON, CHENEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24567 NORTHWESTERN HWY
Mailing Address - Street 2:STE 150
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2421
Mailing Address - Country:US
Mailing Address - Phone:248-799-0093
Mailing Address - Fax:
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:STE 243
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-220-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051352207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104797195Medicaid
MI23D1049104OtherCLEA
MI23D1049104OtherCLEA
MI104797195Medicaid
MIG32503Medicare UPIN