Provider Demographics
NPI:1558661991
Name:JUNITH M. THOMPSON, M.D., S.C.
Entity type:Organization
Organization Name:JUNITH M. THOMPSON, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-657-8360
Mailing Address - Street 1:6530 SHERIDAN ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5063
Mailing Address - Country:US
Mailing Address - Phone:262-657-8360
Mailing Address - Fax:262-657-8389
Practice Address - Street 1:6530 SHERIDAN ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5063
Practice Address - Country:US
Practice Address - Phone:262-657-8360
Practice Address - Fax:262-657-8389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29980-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31520900Medicaid
WI31520900Medicaid
WI31520900Medicaid