| Lighthouse Medical Center Pc | |
|
8251 W 8 Mile Rd Detroit MI 48221-1195 | |
| (313) 345-8120 | |
| (313) 340-9032 |
| Full Name | Lighthouse Medical Center Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8251 W 8 Mile Rd, Detroit, Michigan |
| Authorized Official Name and Position | Willie James Pettiway (MEDICAL DOCTOR) |
| Authorized Official Contact | 3133458120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Medical Center Pc 8251 W 8 Mile Rd Detroit MI 48221-1195 Ph: (313) 345-8120 | Lighthouse Medical Center Pc 8251 W 8 Mile Rd Detroit MI 48221-1195 Ph: (313) 345-8120 |
| NPI Number | 1659520237 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 01/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659520237 | NPI | - | NPPES |
| 1108231742 | Other | MI | BLUE CROSS BLUE SHIELD |
| 3023789 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | WPO49323 (Michigan) | Primary |
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