Provider Demographics
NPI:1851384457
Name:LIGHT, MILES P (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:P
Last Name:LIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3150 HALLMARK CT
Mailing Address - Street 2:STE 3
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2173
Mailing Address - Country:US
Mailing Address - Phone:989-790-9460
Mailing Address - Fax:989-790-9468
Practice Address - Street 1:3150 HALLMARK CT
Practice Address - Street 2:STE 3
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2173
Practice Address - Country:US
Practice Address - Phone:989-790-9460
Practice Address - Fax:989-790-9468
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
381358216OtherCIGNA
1107301291OtherBCBS
MI4301066541OtherSTATE LIC
381358216OtherCIGNA
MI4301066541OtherSTATE LIC