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General NPI Number Information
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NPI Number | 1255369534
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Entity Type | Individual
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Provider Name | MICHAEL J LIGHT MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 400 N 9TH ST FL 3
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City | SPRINGFIELD
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State | IL
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Zip | 62702-5310
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Country | US
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Telephone | 217-545-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E MADISON ST
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City | SPRINGFIELD
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State | IL
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Zip | 62702-5131
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Country | US
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Telephone | 217-545-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | ME81342
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 036.172989
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License Number State | IL
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