Provider Demographics
NPI:1447304498
Name:THOMPSON, MARK STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STANLEY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1031 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5519
Mailing Address - Country:US
Mailing Address - Phone:517-487-5585
Mailing Address - Fax:517-487-1129
Practice Address - Street 1:826 W KING ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2120
Practice Address - Country:US
Practice Address - Phone:517-487-5585
Practice Address - Fax:517-487-1129
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074209207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38 3694638OtherTAX ID
MI4625860Medicaid
MIH65306Medicare UPIN