Provider Demographics
NPI:1518965490
Name:LEHRMAN, KENNETH LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEWIS
Last Name:LEHRMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-778-1702
Practice Address - Street 1:719 SOUTHPOINT BLVD
Practice Address - Street 2:STE B
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1495
Practice Address - Country:US
Practice Address - Phone:707-778-8421
Practice Address - Fax:707-778-1702
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22980207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060070760OtherRAILROAD MEDICARE
CA00G229800OtherBLUE SHIELD OF CALIFORNIA
CA00G229800Medicaid
CA060070760OtherRAILROAD MEDICARE
CAA41798Medicare UPIN
CA00G229805Medicare PIN