Provider Demographics
NPI:1659535953
Name:LIGHT, LISA MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-626-4080
Mailing Address - Fax:330-626-5821
Practice Address - Street 1:8054 DARROW RD STE 4
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2381
Practice Address - Country:US
Practice Address - Phone:330-425-3344
Practice Address - Fax:330-425-8847
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.01023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics