Provider Demographics
NPI:1295396844
Name:THOMPSON, JEREMY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:THOMPSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-8820
Mailing Address - Fax:314-747-2173
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT ANESTHESIOLOGY, STE 14C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-8820
Practice Address - Fax:314-747-2173
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022013199207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200075476Medicaid