NPIMap

Organization Active NPI

George a Lightbourn MD PC

  • Urology Physician
  • Southfield, MI
National Provider Identifier
1083887822
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
GEORGE A LIGHTBOURN MD PC
Practice address
29600 Northwestern Hwy
Suite 104
Southfield, MI 48034-1016
Phone
(248) 353-6599
Fax
(248) 353-6566
NPI assigned
Apr 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Geroge A Lightbourn, M.D.
Title
President
Phone
(248) 353-6599

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

29600 Northwestern Hwy
Suite 104
Southfield, MI 48034-1016

Mailing address

PO Box 937
Southfield, MI 48037-0937
Phone (248) 353-6599

Other identifiers 4

IdentifierTypeStateIssuer
101346646MedicaidMI
3408257131OtherBLUE CROSS BLUE SHIELD
1123970001OtherWELLNESS PLAN
3408257131OtherBLUE CARE NETWORK

National Provider Directory

National Provider Directory

Locations

29600 Northwestern Hwy
Ste 104
Southfield, MI 48034
Phone (248) 353-6599

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1083887822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 937",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480370937",
            "telephone_number": "248-353-6599",
            "fax_number": "248-353-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29600 NORTHWESTERN HWY",
            "address_2": "SUITE 104",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341016",
            "telephone_number": "248-353-6599",
            "fax_number": "248-353-6566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE A LIGHTBOURN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "LIGHTBOURN",
        "authorized_official_first_name": "GEROGE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-353-6599",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101346646",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3408257131",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLNESS PLAN",
            "identifier": "1123970001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "3408257131",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.