Provider Demographics
NPI:1376577981
Name:LIGHTHOUSE CLINIC PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORONDE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-663-6582
Mailing Address - Street 1:29556 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2021
Mailing Address - Country:US
Mailing Address - Phone:248-663-6582
Mailing Address - Fax:
Practice Address - Street 1:29556 SOUTHFIELD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2021
Practice Address - Country:US
Practice Address - Phone:248-663-6582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP28100Medicare ID - Type Unspecified