Individual
KEVIN JAY LYTHGOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 E THOMAS RD, PHOENIX, AZ 85012-3204
(602) 351-2229
(602) 351-1500
Mailing address
1661 E CAMELBACK RD STE 205, PHOENIX, AZ 85016-3913
(602) 422-9000
(602) 556-5951
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21855
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198433
—
AZ
01
—
1Z1309
HEALTH NET
AZ
01
—
3372334
CIGNA
AZ
01
—
860966838
TAX ID
AZ
01
—
AZ0860720
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
08/16/2005
Last updated
01/26/2021
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