Provider Demographics
NPI:1952384372
Name:THOMPSON-BUSCH, ANGELA KAY (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAY
Last Name:THOMPSON-BUSCH
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,PHD
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-8100
Mailing Address - Fax:616-391-8897
Practice Address - Street 1:330 BARCLAY AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2556
Practice Address - Country:US
Practice Address - Phone:616-391-8100
Practice Address - Fax:616-391-8897
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN554147600Medicare ID - Type Unspecified
MIM33350273Medicare PIN
MN370002483Medicare ID - Type Unspecified
MNHO5286Medicare UPIN