Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 4301051352 | MI |
NPI | 1043353477 |
---|---|
Provider Name | Dr. Cheney Thompson |
First Address | Southfield, MI 48075-2421 |
Second Address | Birmingham, MI 48009-6902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 16/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104797195 | (05) | MI |
23D1049104 | CLEA (01) | MI |
BT4609434 | DEA (01) | MI |
G32503 | (02) | MI |