Provider Demographics
NPI:1720107816
Name:THOMPSON, ANDREW DAVID (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:DMC HARPER UNIVERSITY HOSPITAL, DEPARTMENT OF PATHOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-8555
Practice Address - Fax:313-745-9299
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301001033207ZC0500X, 207ZP0102X
NC2006-00866207ZD0900X
GA57854207ZD0900X
SC29128207ZD0900X
CAA77438207ZD0900X
MI4301101033207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630807Medicare PIN