Healthcare Provider Details

I. General information

NPI: 1700411923
Provider Name (Legal Business Name): CANCER AND BLOOD SPECIALISTS OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 HARCOURT RD STE 205
INDIANAPOLIS IN
46260-2082
US

IV. Provider business mailing address

13125 DUMBARTON ST
CARMEL IN
46032-7320
US

V. Phone/Fax

Practice location:
  • Phone: 317-228-3393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. SRIDHAR REDDY BOLLA
Title or Position: CEO
Credential: MD
Phone: 317-373-6662