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General NPI Number Information
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NPI Number | 1912710922
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Entity Type | Organization
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Legal Business Name | POLAR STAR MEDICAL
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1510 E WAGON WHEEL LN STE 105
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-6698
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Country | US
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Telephone | 904-994-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 E WAGON WHEEL LN STE 110
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-6698
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Country | US
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Telephone | 904-994-5560
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NITISH AGGARWAL
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Credential | MD
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Telephone | 725-222-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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