Individual
REBECCA L THORESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
404 HAZEN ST, SUITE 101, PAW PAW, MI 49079-1040
(269) 657-4407
(269) 657-0965
Mailing address
601 JOHN ST, SUITE 101, KALAMAZOO, MI 49007-5341
(269) 657-4407
(269) 657-0965
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R7645
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235131137
BCBSM - BLH TAX ID
MI
05
—
1477762441
—
MI
Enumeration date
05/22/2007
Last updated
10/14/2014
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