Provider Demographics
NPI:1942382924
Name:THOMPSON, BRUCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22725 DOREMUS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3421
Mailing Address - Country:US
Mailing Address - Phone:248-342-0475
Mailing Address - Fax:586-759-3099
Practice Address - Street 1:13355 E 10 MILE RD
Practice Address - Street 2:HENRY FORD BICOUNTY HOSPITAL
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-759-7314
Practice Address - Fax:586-759-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI23701-020207P00000X
MI207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1734594Medicare ID - Type Unspecified