Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lisle Blackbourn

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1043960156

Lisle Blackbourn is a Student in an Organized Health Care Education/Training Program in Ann Arbor, Michigan. Licensed in Illinois and Michigan. Registered with an NPI since 2022.

Licensed in
IL, MI
In the registry since
2022
Specialties on file
3

Practice location Address checks out

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone: (734) 936-4000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence 4301515945 (MI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 90200000X (IL)

Record details

NPI number1043960156
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 24, 2022
Last updated in NPPESJuly 2, 2026
Certification dateJuly 2, 2026
Mailing address1500 E Medical Center Dr, Ann Arbor, MI 48109-5000

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