Individual
DR. KENNETH M THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 E MICHIGAN AVE, STE 245A, LANSING, MI 48912-1800
(517) 364-5710
(517) 364-5717
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
(517) 364-6253
(517) 364-6208
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301046262
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803310881
BCBS INDIVIDUAL PIN
MI
05
—
3342468
—
MI
05
—
3342593
—
MI
05
—
4288457
—
MI
Enumeration date
09/16/2006
Last updated
07/08/2007
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