Lighthouse Medical Center PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

WPO49323 Issued in MI

Legal business name

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

Organization subpart

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lighthouse Medical Center PC Doing business as

Locations

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1108231742",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3023789",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Medical Center PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lakisha M Lige, CNA
• Lanet R Lige
• Light of Hope Family Medical Clinic
• Light of Recovery Inc
• Marissa Lightbourne, MD
• Lightyear Health Clinic Michigan, PC
• Naomi Ligon, LBSW
• Keerteshwrya Likes, MD
• Trevor Lile
• Lilian Lai MD PC

• Internal Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Internal Medicine Physician in Michigan

• 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.

Verify at the official NPI Registry.