Individual
DR. MILES P LIGHT
Active
Individual
DR. MILES P LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301066541
MI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1107301291
BCBS
—
01
—
381358216
CIGNA
—
01
—
4301066541
STATE LIC
MI
Enumeration date
08/30/2005
Last updated
03/03/2025
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