Individual
MICHELE L THURSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1355 MARINERS DR, WARSAW, IN 46582-7145
(574) 267-6778
(574) 267-3134
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061461A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000655778
ANTHEM
IN
05
—
200825560
—
IN
05
—
200956680
—
IN
Enumeration date
08/11/2006
Last updated
10/17/2022
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