Provider Demographics
NPI:1851751283
Name:MICHELE M THOMPSON MD LLC
Entity Type:Organization
Organization Name:MICHELE M THOMPSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-450-6800
Mailing Address - Street 1:234 SE 136TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6923
Mailing Address - Country:US
Mailing Address - Phone:360-450-6800
Mailing Address - Fax:360-989-1150
Practice Address - Street 1:234 SE 136TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6923
Practice Address - Country:US
Practice Address - Phone:360-450-6800
Practice Address - Fax:360-989-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty