Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | ME81342 | FL |
NPI | 1255369534 |
---|---|
Provider Name | Dr. Michael J Light |
First Address | Miami, FL 33136-1051 |
Second Address | Miami, FL 33136-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 27/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015095400 | (05) | FL |
E95658 | (02) | FL |