Organization
HAVASU CARDIAC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PANKAJ KULSHRESTHA M.D. (OWNER/MEMBER)
(917) 536-6453
Entity
Organization
Contact information
Practice address
1741 MESQUITE AVE, STE. A200, LAKE HAVASU CITY, AZ 86403-5695
(917) 536-6453
(888) 491-7482
Mailing address
PO BOX 707, LAKE HAVASU CITY, AZ 86405-0707
(917) 536-6453
(888) 491-7482
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
36397
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016115
—
AZ
01
—
P-1944708-5
CORPORATION NUMBER
AZ
Enumeration date
08/18/2014
Last updated
02/22/2017
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