Basic Information
| Provider Information | |||||||||
| NPI: | 1740290360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIGHTHEART | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 MEDICAL CENTER DRIVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826606 | ||||||||
| FaxNumber: | 5412826601 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MEDICAL CENTER DRIVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826606 | ||||||||
| FaxNumber: | 5412826601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD22698 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.