Provider Demographics
NPI:1033543186
Name:HOSSTRUP, PLC
Entity Type:Organization
Organization Name:HOSSTRUP, PLC
Other - Org Name:AZ VASCULAR & THORACIC SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAHAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-512-4326
Mailing Address - Street 1:6120 W BELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3781
Mailing Address - Country:US
Mailing Address - Phone:623-512-4326
Mailing Address - Fax:623-584-6732
Practice Address - Street 1:6120 W BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3781
Practice Address - Country:US
Practice Address - Phone:623-512-4326
Practice Address - Fax:623-584-6732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41460208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z161011Medicare PIN