MEDICARE: HAVASU CARDIAC SURGERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	36397	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P-1944708-5	OTHER	AZ	CORPORATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063811859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVASU CARDIAC SURGERY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 707
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-0707
Country	:	US
Telephone Number	:	917-536-6453
Fax Number	:	888-491-7482

Provider Business Practice Location Address
First Line	:	1741 MESQUITE AVE
Second Line	:	STE. A200
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5695
Country	:	US
Telephone Number	:	917-536-6453
Fax Number	:	888-491-7482

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	PANKAJ KULSHRESTHA
Credential	:	M.D.
Telephone Number	:	917-536-6453

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	02/22/2017

Similar Medicare Providers

1063553543 — MANU LONIAL M.D.
Practice Location Address:

1741 MESQUITE AVE # 100
LAKE HAVASU CITY, AZ
86403-5695

Practice Phone: 928-782-7972
Practice Fax: 928-329-4522

1386819142 — WAL-MART STORE, INC.
Practice Location Address:

5695 HWY 95 N
LAKE HAVASU CITY, AZ
86403-9646

Practice Phone: 928-764-3755
Practice Fax: 928-472-2815

1801194352 — LAKESIDE HEART AND VASCULAR CENTER PLLC
Practice Location Address:

1741 MESQUITE AVE , SUITE A100
LAKE HAVASU CITY, AZ
86403-5695

Practice Phone: 928-453-2727
Practice Fax: 928-453-2828

1164449377 — WALMART INC.
Practice Location Address:

5695 HIGHWAY 95 N
LAKE HAVASU CITY, AZ
86404-9646

Practice Phone: 928-453-8515
Practice Fax:

1508275561 — ELIZABETH NOVELEN
Practice Location Address:

5695 HIGHWAY 95 N
LAKE HAVASU CITY, AZ
86404-9646

Practice Phone: 928-764-3737
Practice Fax: 928-764-3740

1619356680 — DR. TIMOTHY A YOUSO PHARM D
Practice Location Address:

5695 HIGHWAY 95 N
LAKE HAVASU CITY, AZ
86404-9646

Practice Phone: 928-764-3737
Practice Fax:

Directions to “HAVASU CARDIAC SURGERY PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.