Provider Demographics
NPI:1093763369
Name:THOMPSON, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1282
Mailing Address - Country:US
Mailing Address - Phone:734-439-8433
Mailing Address - Fax:734-439-8455
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1282
Practice Address - Country:US
Practice Address - Phone:734-439-8433
Practice Address - Fax:734-439-8455
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM14041Medicare PIN
OHTH4178511Medicare ID - Type Unspecified