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General NPI Number Information
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NPI Number | 1457906000
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Entity Type | Organization
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Legal Business Name | CARDINAL FIVE GROUP
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 1732 W SAM HOUSTON PKWY N
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City | HOUSTON
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State | TX
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Zip | 77043-2723
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Country | US
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Telephone | 888-300-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 SPRING GREEN BLVD STE 120-343
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City | KATY
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State | TX
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Zip | 77494-7462
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Country | US
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Telephone | 832-633-5292
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | EVANS TACHIE-MENSON
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Credential |
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Telephone | 832-633-5292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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