Individual
DR. JUSTIN JEREMIAH LIGHTBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1855 S MAIN ST, GOSHEN, IN 46526-4852
(574) 533-7476
(574) 533-7145
Mailing address
PO BOX 834, GOSHEN, IN 46527-0834
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01073831A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01073831A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201107430
—
IN
Enumeration date
06/23/2008
Last updated
04/24/2023
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