Provider Demographics
NPI:1851841084
Name:KETTERING CARDIOTHORACIC AND VASCULAR SURGEONS, INC
Entity Type:Organization
Organization Name:KETTERING CARDIOTHORACIC AND VASCULAR SURGEONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHASLING
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO-CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:734-664-7820
Mailing Address - Street 1:3533 SOUTHERN BLVD STE 5650
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1263
Mailing Address - Country:US
Mailing Address - Phone:937-294-3611
Mailing Address - Fax:937-294-9010
Practice Address - Street 1:3533 SOUTHERN BLVD STE 5650
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1263
Practice Address - Country:US
Practice Address - Phone:937-294-3611
Practice Address - Fax:937-294-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty