Provider Demographics
NPI:1588236921
Name:ANDREW THOMPSON DPM FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:ANDREW THOMPSON DPM FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-210-5257
Mailing Address - Street 1:295 CLOVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3303
Mailing Address - Country:US
Mailing Address - Phone:248-210-5257
Mailing Address - Fax:
Practice Address - Street 1:18530 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2319
Practice Address - Country:US
Practice Address - Phone:248-210-5257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric