Provider Demographics
NPI:1740290360
Name:LIGHTHEART, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:LIGHTHEART
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Gender:M
Credentials:MD
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Mailing Address - Street 1:520 MEDICAL CENTER DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4314
Mailing Address - Country:US
Mailing Address - Phone:541-282-6606
Mailing Address - Fax:541-282-6601
Practice Address - Street 1:520 MEDICAL CENTER DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4314
Practice Address - Country:US
Practice Address - Phone:541-282-6606
Practice Address - Fax:541-282-6601
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-11-15
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Provider Licenses
StateLicense IDTaxonomies
ORMD22698207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease