Active NPI
Lighthouse Medical Center PC
- Internal Medicine Physician
- Detroit, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- WPO49323
- Legal business name
- LIGHTHOUSE MEDICAL CENTER PC
- Doing business as
- Lighthouse Medical Center PC
- Practice address
- 8251 W 8 Mile Rd
Detroit, MI 48221-1195 - Phone
- (313) 345-8120
- Fax
- (313) 340-9032
- NPI assigned
- Sep 18, 2008
- Last updated
- Jan 13, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Willie James Pettiway Sr., M.D.
- Title
- Medical Doctor
- Phone
- (313) 345-8120
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | WPO49323 | MI | Primary |
Addresses
Primary practice location
8251 W 8 Mile Rd
Detroit, MI 48221-1195
Mailing address
8251 W 8 Mile Rd
Detroit, MI 48221-1195
Phone (313) 345-8120
Other names 1
- Lighthouse Medical Center PC
National Provider Directory
National Provider DirectoryLocations
8251 W 8 Mile Rd
Detroit, MI 48221
Phone (313) 345-8120
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Detroit, MI
- NPI 1275669293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1294876800000",
"number": "1659520237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8251 W 8 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482211195",
"telephone_number": "313-345-8120",
"fax_number": "313-345-4478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8251 W 8 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482211195",
"telephone_number": "313-345-8120",
"fax_number": "313-340-9032"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIGHTHOUSE MEDICAL CENTER PC",
"organizational_subpart": "NO",
"enumeration_date": "2008-09-18",
"last_updated": "2011-01-13",
"status": "A",
"authorized_official_last_name": "PETTIWAY",
"authorized_official_first_name": "WILLIE",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "MEDICAL DOCTOR",
"authorized_official_telephone_number": "313-345-8120",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "MI",
"license": "WPO49323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Lighthouse Medical Center PC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.