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NPI Code Detail

MEDICARE: LIGHTHOUSE FAMILY MEDICINE, PLLC

MEDICARE: LIGHTHOUSE FAMILY MEDICINE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301088847MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114222031
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE FAMILY MEDICINE, PLLC
Provider Business Mailing Address
First Line : 4071 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3801
Country : US
Telephone Number : 810-824-4222
Fax Number : 810-824-4220
Provider Business Practice Location Address
First Line : 4071 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3801
Country : US
Telephone Number : 810-824-4222
Fax Number : 810-824-4220
Authorized Official
Title or Position : MEDICAL DOCTOR
Name : DR. G. BLAIR DOWDEN
Credential : M.D.
Telephone Number : 810-824-4222
Provider Enumeration Date : 01/25/2011
Last Update Date : 01/25/2011

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Directions to “LIGHTHOUSE FAMILY MEDICINE, PLLC ” Practice Location

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