Provider Demographics
NPI:1467463398
Name:CARDIAC & VASCULAR PHYSICIANS
Entity Type:Organization
Organization Name:CARDIAC & VASCULAR PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:PANTE
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-791-1743
Mailing Address - Street 1:PO BOX 781348
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-8348
Mailing Address - Country:US
Mailing Address - Phone:317-791-1743
Mailing Address - Fax:317-791-1765
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:SUITE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8668
Practice Address - Country:US
Practice Address - Phone:317-859-3095
Practice Address - Fax:317-791-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01040595A246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20061410Medicaid
INE93918Medicare UPIN
IN20061410Medicaid