Healthcare Provider Details

I. General information

NPI: 1043222029
Provider Name (Legal Business Name): JOHN P. LOVENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOONBOW PLZ
CORBIN KY
40701-8949
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-9010
  • Fax: 606-528-0028
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20074
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: