Provider Demographics
NPI:1588393938
Name:DR LIGHTHOUSE LLC
Entity type:Organization
Organization Name:DR LIGHTHOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-410-3127
Mailing Address - Street 1:2436 N FEDERAL HWY # 158
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6854
Mailing Address - Country:US
Mailing Address - Phone:954-860-7997
Mailing Address - Fax:
Practice Address - Street 1:4111 NE 23RD TER
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-8013
Practice Address - Country:US
Practice Address - Phone:954-860-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty