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General NPI Number Information
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NPI Number | 1295059129
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Entity Type | Organization
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Legal Business Name | DAYTON CARDIAC SURGERY
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 627 S EDWIN C MOSES BLVD SUITE EMP 5J
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City | DAYTON
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State | OH
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Zip | 45417-3461
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Country | US
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Telephone | 937-938-9194
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Fax | 937-938-9242
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Provider Business Mailing Address
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Address Line | PO BOX 750243
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City | DAYTON
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State | OH
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Zip | 45475-0243
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Country | US
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Telephone | 937-938-9194
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Fax | 937-938-9242
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PANKAJ KULSHRESTHA
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Credential | M.D.
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Telephone | 937-938-9194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 35088325
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License Number State | OH
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