MEDICARE: DR LIGHTHOUSE LLC

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
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1588393938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LIGHTHOUSE LLC

Provider Business Mailing Address
First Line	:	2436 N FEDERAL HWY # 158
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6854
Country	:	US
Telephone Number	:	954-860-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 NE 23RD TER
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8013
Country	:	US
Telephone Number	:	954-860-7997
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RYAN TAUBE
Credential	:	DO
Telephone Number	:	248-410-3127

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	06/09/2022

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Directions to “DR LIGHTHOUSE LLC ” Practice Location

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