Individual
BETHANIE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
721 3 MILE RD NW STE 200, GRAND RAPIDS, MI 49544-8224
(616) 647-3777
(616) 647-3776
Mailing address
721 3 MILE RD NW STE 200, GRAND RAPIDS, MI 49544-8224
(616) 647-3777
(616) 647-3776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301084062
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804116382
BCBS
MI
01
—
1598712390
GROUP NPI
MI
01
—
4301084062
STATE LICENSE
MI
05
—
4905443
—
MI
05
—
4905452
—
MI
05
—
4905461
—
MI
05
—
4905470
—
MI
05
—
4905480
—
MI
Enumeration date
08/16/2006
Last updated
09/05/2008
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