Provider Demographics
NPI:1285700013
Name:THOMPSON, MICHAEL G (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0644
Mailing Address - Country:US
Mailing Address - Phone:845-635-3660
Mailing Address - Fax:
Practice Address - Street 1:1583 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-0644
Practice Address - Country:US
Practice Address - Phone:845-635-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0028811213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00535575Medicaid
T50898Medicare UPIN
NYP31731Medicare ID - Type Unspecified