Phillip Glenn Lougheed, FNP-BC, RN

Individual provider Active NPI Nurse Practitioner · Bingham Farms, MI

NPI 1215528997 · NPPES record last updated Jan 27, 2021

Key facts

NPI
1215528997
Entity type
Individual (NPI type 1)
Primary specialty
Nurse Practitioner 363L00000X
License
F10201475 (MI)
Practice address
24255 W 13 Mile Rd
Bingham Farms, MI 48025-4320
Phone
(248) 723-9613
NPI assigned
Jan 27, 2021
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
F10201475MIMDNurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F10201475 MI Yes

Addresses

Primary practice location

24255 W 13 Mile Rd
Bingham Farms, MI 48025-4320

Mailing address

413 Walnut Ave
Royal Oak, MI 48073-5310
Phone (810) 938-8201

Other providers in Bingham Farms, MI

All providers in Bingham Farms, MI · Nurse Practitioner in Michigan

Sources for this page

Verify at the official NPI Registry.