Healthcare Provider Details

I. General information

NPI: 1578527826
Provider Name (Legal Business Name): NORTHWEST CANCER CENTERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CALUMET AVE
DYER IN
46311-1596
US

IV. Provider business mailing address

1001 CALUMET AVE
DYER IN
46311-1596
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-8178
  • Fax: 219-924-8314
Mailing address:
  • Phone: 219-924-8178
  • Fax: 219-924-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMAD KASSAR
Title or Position: PRESIDENT
Credential:
Phone: 219-924-8178