Healthcare Provider Details

I. General information

NPI: 1942281654
Provider Name (Legal Business Name): KELVIN S PANESAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST 308
SCOTTSDALE AZ
85258-4510
US

IV. Provider business mailing address

PO BOX 9362
BELFAST ME
04915-9362
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2260
  • Fax: 480-892-2274
Mailing address:
  • Phone: 480-892-2260
  • Fax: 480-892-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number26415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: