Provider Demographics
NPI:1841414745
Name:ROBERT E THOMPSON MD AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ROBERT E THOMPSON MD AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-358-8083
Mailing Address - Street 1:109 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2301
Mailing Address - Country:US
Mailing Address - Phone:989-354-0845
Mailing Address - Fax:989-354-2966
Practice Address - Street 1:2578 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4618
Practice Address - Country:US
Practice Address - Phone:989-358-8083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0800410402OtherBLUE CROSS BLUE SHIELD OF
MID86534Medicare UPIN
MI0800410402OtherBLUE CROSS BLUE SHIELD OF