Healthcare Provider Details

I. General information

NPI: 1396736435
Provider Name (Legal Business Name): CANCER AND BLOOD DISEASE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CHESTER BLVD SUITE C
RICHMOND IN
47374-1908
US

IV. Provider business mailing address

1401 CHESTER BLVD SUITE C
RICHMOND IN
47374-1908
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3245
  • Fax: 765-983-3247
Mailing address:
  • Phone: 765-983-3245
  • Fax: 765-983-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number50003335
License Number StateIN

VIII. Authorized Official

Name: DR. BHARAT L. AGRAWAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 765-983-3245