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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LISLE BLACKBOURN
NPI 1043960156
Student in an Organized Health Care Education/Training Program in Ann Arbor, MI

Active since March 24, 2022
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109(734) 936-4000 Get Directions Write a Review

NPPES record last updated: July 2, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lisle Blackbourn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISLE BLACKBOURN (NPI 1043960156) is an individual student in an organized health care education/training program in Ann Arbor, Michigan, licensed in Michigan (4301515945) and active in the NPI registry since March 2022.

NPPES Registry Identity

NPI1043960156
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameLISLE BLACKBOURN
Location Address1500 E MEDICAL CENTER DRAnn Arbor, MI 48109-5000
Mailing Address1500 E Medical Center DrAnn Arbor, MI 48109-5000 · (734) 936-4000
Phone(734) 936-4000
Sole ProprietorNo
Enumeration DateMarch 24, 2022
Last NPPES UpdateJuly 2, 2026
NPPES CertifiedJuly 2, 2026
✔ NPI 1043960156 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Licenses✔ Licensed in MI · 4301515945✔ Licensed in IL · 90200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1500 E MEDICAL CENTER DR, Ann Arbor, MI 48109
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LOKMAN SUNG MD
Pathology (Forensic Pathology)
1500 E MEDICAL CENTER DR, 2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY
ANN ARBOR, MI 48109
Washtenaw County (800) 862-7284
SAMEER DEV SAINI M.D.
Internal Medicine (Gastroenterology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-4000
KYLE DAVID PERRY MD
Pathology (Cytopathology)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-4000
DR. DAVID ALEXANDER STEWART M.D.
Pediatrics
1500 E MEDICAL CENTER DR, 12TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL ROOM 525
ANN ARBOR, MI 48109
Washtenaw County (734) 763-5302
DR. MICHAEL EDMUND WATSON MD
Pediatrics (Pediatric Infectious Diseases)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-4000
CARRIE KRAEGER PORTER PA-C
Physician Assistant
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-6666
DENISE LYNN BERRY CRNA
Nurse Anesthetist, Certified Registered
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-4000
KETTI SOPHIA PETERSEN MD
Family Medicine (Hospice and Palliative Medicine)
1500 E MEDICAL CENTER DR
ANN ARBOR, MI 48109
Washtenaw County (734) 936-4000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lisle Blackbourn's NPI number?

The NPI number for Lisle Blackbourn is 1043960156. It was assigned to this individual provider in the NPPES registry on March 24, 2022.

Where is Lisle Blackbourn located?

Lisle Blackbourn practices at 1500 E Medical Center Dr, Ann Arbor, MI 48109. The listed phone number is (734) 936-4000.

What is Lisle Blackbourn's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Lisle Blackbourn was last updated on July 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 38 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.