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General NPI Number Information
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NPI Number | 1083887822
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Entity Type | Organization
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Legal Business Name | GEORGE A LIGHTBOURN MD PC
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 29600 NORTHWESTERN HWY SUITE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1016
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Country | US
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Telephone | 248-353-6599
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Fax | 248-353-6566
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Provider Business Mailing Address
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Address Line | PO BOX 937
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City | SOUTHFIELD
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State | MI
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Zip | 48037-0937
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Country | US
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Telephone | 248-353-6599
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Fax | 248-353-6566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEROGE A LIGHTBOURN
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Credential | M.D.
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Telephone | 248-353-6599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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