Provider Demographics
NPI:1740244169
Name:THOMPSON, PAMELA (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:THOMPSON
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4221 CHARLAR DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842
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
Practice Address - Country:US
Practice Address - Phone:517-694-7600
Practice Address - Fax:517-694-7003
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853310394OtherBCBS
MI4570305Medicaid
MI0N85500Medicare ID - Type Unspecified
P68306Medicare UPIN
MI0N85500001Medicare PIN