Provider Demographics
NPI:1932195963
Name:THOMPSON, MICHAEL GLASS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GLASS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:189 WEST HWY 192 BYPASS
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741
Mailing Address - Country:US
Mailing Address - Phone:859-252-6500
Mailing Address - Fax:606-877-5454
Practice Address - Street 1:189 HIGHWAY 192 W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2428
Practice Address - Country:US
Practice Address - Phone:859-252-6500
Practice Address - Fax:606-877-5454
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100075660Medicaid
KY7100075660Medicaid
KY3321197Medicare PIN