Provider Demographics
NPI:1396736435
Name:CANCER AND BLOOD DISEASE CENTER
Entity type:Organization
Organization Name:CANCER AND BLOOD DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:L
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-983-3245
Mailing Address - Street 1:1401 CHESTER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1908
Mailing Address - Country:US
Mailing Address - Phone:765-983-3245
Mailing Address - Fax:765-983-3247
Practice Address - Street 1:1401 CHESTER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1908
Practice Address - Country:US
Practice Address - Phone:765-983-3245
Practice Address - Fax:765-983-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003335207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845152Medicaid
OH0845152Medicaid
IN904680AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER