Provider Demographics
NPI:1700411923
Name:CANCER AND BLOOD SPECIALISTS OF INDIANA LLC
Entity Type:Organization
Organization Name:CANCER AND BLOOD SPECIALISTS OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-373-6662
Mailing Address - Street 1:13125 DUMBARTON ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8301 HARCOURT RD STE 205
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2082
Practice Address - Country:US
Practice Address - Phone:317-228-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty