Provider Demographics
NPI:1326148032
Name:THORNBURG, JOHN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:THORNBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:D128 WEST FEE HALL
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-355-3503
Mailing Address - Fax:517-432-1167
Practice Address - Street 1:138 SERVICE ROAD
Practice Address - Street 2:SUITE A235
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1313
Practice Address - Country:US
Practice Address - Phone:517-355-1300
Practice Address - Fax:517-355-1710
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1281078Medicaid
MIE26201Medicare UPIN
MIC36082046Medicare ID - Type Unspecified