Provider Demographics
NPI:1629204797
Name:KONJA, CASSIE TOMINNA (DO)
Entity Type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:TOMINNA
Last Name:KONJA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:12000 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3570
Practice Address - Country:US
Practice Address - Phone:586-576-4140
Practice Address - Fax:586-576-4146
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2015-08-27
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Provider Licenses
StateLicense IDTaxonomies
MI5101018206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine