Healthcare Provider Details

I. General information

NPI: 1295059129
Provider Name (Legal Business Name): DAYTON CARDIAC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 S EDWIN C MOSES BLVD SUITE EMP 5J
DAYTON OH
45417-3461
US

IV. Provider business mailing address

PO BOX 750243
DAYTON OH
45475-0243
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-9194
  • Fax: 937-938-9242
Mailing address:
  • Phone: 937-938-9194
  • Fax: 937-938-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35088325
License Number StateOH

VIII. Authorized Official

Name: DR. PANKAJ KULSHRESTHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-938-9194