Provider Demographics
NPI:1063837292
Name:LIGHT, MICHAEL II (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LIGHT
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VILLAGE GRN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8803
Mailing Address - Country:US
Mailing Address - Phone:508-224-2224
Mailing Address - Fax:
Practice Address - Street 1:3 VILLAGE GRN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8803
Practice Address - Country:US
Practice Address - Phone:508-224-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204325207R00000X
MA282933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine