Organization
LIGHTHOUSE PROFESSIONAL CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY L SEUFERER D.O. (OWNER)
(231) 843-8877
Entity
Organization
Contact information
Practice address
409 W LUDINGTON AVE STE 307, LUDINGTON, MI 49431-2377
(231) 843-8877
(231) 845-0264
Mailing address
409 W LUDINGTON AVE STE 307, LUDINGTON, MI 49431-2377
(231) 843-8877
(231) 845-0264
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
MI
2084P0800X
Psychiatry Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100E310320
BLUE CROSS BLUE SHIELD
MI
01
—
100E361760
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
01
—
800E310020
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
01/26/2007
Last updated
06/05/2008
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