Provider Demographics
NPI:1295727253
Name:LYTHGOE, KEVIN JAY (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAY
Last Name:LYTHGOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 E CAMELBACK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3913
Mailing Address - Country:US
Mailing Address - Phone:602-422-9000
Mailing Address - Fax:602-556-5951
Practice Address - Street 1:530 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3204
Practice Address - Country:US
Practice Address - Phone:602-351-2229
Practice Address - Fax:602-351-1500
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860966838OtherTAX ID
AZAZ0860720OtherBLUE CROSS BLUE SHIELD
AZ198433Medicaid
AZ3372334OtherCIGNA
AZ1Z1309OtherHEALTH NET
AZAZ0860720OtherBLUE CROSS BLUE SHIELD
AZG02682Medicare UPIN
AZ111845Medicare PIN