Provider Demographics
NPI:1821316761
Name:CANCER IM INC
Entity Type:Organization
Organization Name:CANCER IM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2817-488-5555
Mailing Address - Street 1:4810 WILLOWBEND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3510
Mailing Address - Country:US
Mailing Address - Phone:281-748-5555
Mailing Address - Fax:
Practice Address - Street 1:12000 RICHMOND AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2431
Practice Address - Country:US
Practice Address - Phone:281-748-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8907207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty