Organization
LEE CANCER CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHANUPRASAD KONERU M.D. (MANAGING DIRECTOR)
(239) 278-1911
Entity
Organization
Contact information
Practice address
12781 WORLD PLAZA LN, UNIT 1, FORT MYERS, FL 33907-4078
(239) 278-1911
(239) 278-4511
Mailing address
12781 WORLD PLAZA LN STE 1, FORT MYERS, FL 33907-4078
(239) 278-1911
(239) 278-4511
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
ME 75079
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K6032
MEDICARE GROUP SENDER
FL
Enumeration date
09/26/2007
Last updated
12/02/2008
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