Provider Demographics
NPI:1093817751
Name:LUM, JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:LUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1096 S BELSAY RD
Mailing Address - Street 2:STE D
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1948
Mailing Address - Country:US
Mailing Address - Phone:810-743-3880
Mailing Address - Fax:810-743-3886
Practice Address - Street 1:1096 S BELSAY RD
Practice Address - Street 2:SUITE D
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-743-3880
Practice Address - Fax:810-743-3886
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4472144Medicaid
MIE37372Medicare UPIN
MIM23560132Medicare PIN