Provider Demographics
NPI:1649649484
Name:POG CEDAR RAPIDS LLC
Entity type:Organization
Organization Name:POG CEDAR RAPIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAGENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONERU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-556-3175
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-1086
Mailing Address - Country:US
Mailing Address - Phone:563-556-3175
Mailing Address - Fax:563-594-5256
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:STE 285
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-861-6944
Practice Address - Fax:319-861-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty