Lighthouse Family Medicine, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301088847 Issued in MI

Legal business name

LIGHTHOUSE FAMILY MEDICINE, PLLC

Practice address

4071 24TH Ave
Fort Gratiot, MI 48059-3801

Phone

(810) 824-4222

Fax

(810) 824-4220

NPI assigned

Jan 25, 2011

Organization subpart

No

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

Authorized official

Name

Dr. G. Blair Dowden, M.D.

Title

Medical Doctor

Phone

(810) 824-4222

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laural K Wagley, NP

  • Family Nurse Practitioner
  • Clinton TWP, MI
  • NPI 1497065635
  NPD (past)

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1114222031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4071 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593801",
            "telephone_number": "810-824-4222",
            "fax_number": "810-824-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4071 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593801",
            "telephone_number": "810-824-4222",
            "fax_number": "810-824-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "DOWDEN",
        "authorized_official_first_name": "G.",
        "authorized_official_middle_name": "BLAIR",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "810-824-4222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301088847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750379194",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna R Letzgus
• Jessica Ryann Lewis
• Lauren E Lewis
• Linda A Liethen, LLP
• Philip Charles Liethen, PHD
• Lincare Inc (United Medical)
• Live Big & Loud LLC
• Swinder Logue
• Skylar London
• Henry R Lootens, RPH

• Family Medicine Physician in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; 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.