Provider Demographics
NPI:1629249990
Name:PAMELA THOMPSON DO PLLC
Entity Type:Organization
Organization Name:PAMELA THOMPSON DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-694-7600
Mailing Address - Street 1:4221 CHARLAR DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-6804
Mailing Address - Country:US
Mailing Address - Phone:517-694-7600
Mailing Address - Fax:517-694-7003
Practice Address - Street 1:4221 CHARLAR DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-6804
Practice Address - Country:US
Practice Address - Phone:517-694-7600
Practice Address - Fax:517-694-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009580207Q00000X
MI5601005021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4570305Medicaid
MIQ79220Medicare UPIN
MIF03707Medicare UPIN