Provider Demographics
NPI:1063629087
Name:HAVASU SURGICAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:HAVASU SURGICAL SPECIALISTS, PC
Other - Org Name:ALEXANDER ZILBERMAN, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIESDORPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-854-6508
Mailing Address - Street 1:1972 MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5729
Mailing Address - Country:US
Mailing Address - Phone:928-854-6508
Mailing Address - Fax:928-854-6206
Practice Address - Street 1:1972 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5729
Practice Address - Country:US
Practice Address - Phone:928-854-6508
Practice Address - Fax:928-854-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ753261Medicaid
AZ74526Medicare ID - Type Unspecified
AZ753261Medicaid