Organization
GEORGE A LIGHTBOURN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEROGE A LIGHTBOURN M.D. (PRESIDENT)
(248) 353-6599
Entity
Organization
Contact information
Practice address
29600 NORTHWESTERN HWY, SUITE 104, SOUTHFIELD, MI 48034-1016
(248) 353-6599
(248) 353-6566
Mailing address
PO BOX 937, SOUTHFIELD, MI 48037-0937
(248) 353-6599
(248) 353-6566
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101346646
—
MI
01
—
1123970001
WELLNESS PLAN
—
01
—
3408257131
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/11/2008
Last updated
12/11/2013
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