Shining Light Osteopathic Care PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

5101014290 Issued in MI

Legal business name

SHINING LIGHT OSTEOPATHIC CARE PLLC

Practice address

15300 21 Mile Rd Ste 3
Macomb, MI 48044-5024

Phone

(586) 799-7682

Fax

(586) 799-7827

NPI assigned

Mar 15, 2018

Organization subpart

No

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

Authorized official

Name

Lori Ann Dillard, DO

Title

Owner/Physician

Phone

(586) 799-7682

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1669975678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 21 MILE RD STE 3",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445024",
            "telephone_number": "586-799-7682",
            "fax_number": "586-799-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 21 MILE RD STE 3",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445024",
            "telephone_number": "586-799-7682",
            "fax_number": "586-799-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING LIGHT OSTEOPATHIC CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "DILLARD",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "586-799-7682",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MI",
            "license": "5101014290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seton Health Corporation of Southeastern Michigan (23 Mile Urgent Care)
• Sandy Shammami
• Mina Karam Shammas
• Nicholas Shamoun, DPT
• Jordan Patrick Sharon, RN
• Rachel Marie Shoff, PTA
• Gregory Shonk, RN
• Shugababies
• Omama Siddiqui, MD
• Gurbahar Singh Sidhu

• Medical Specialty Clinic/Center in Macomb, MI
• Providers in Macomb, MI by specialty
• Medical Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.