Provider Demographics
NPI:1356312631
Name:THOMPSON, KRIS ELLYN (MD)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:ELLYN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:ELLYN
Other - Last Name:COLE-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3671 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9308
Mailing Address - Country:US
Mailing Address - Phone:734-747-8960
Mailing Address - Fax:734-747-8687
Practice Address - Street 1:8641 W GRAND RIVER
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2328
Practice Address - Country:US
Practice Address - Phone:810-494-4000
Practice Address - Fax:810-494-5118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI052233208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0811010Medicare ID - Type Unspecified
MIE26845Medicare UPIN