Provider Demographics
NPI:1881756336
Name:CARDIAC & VASCULAR PHYSICIANS
Entity type:Organization
Organization Name:CARDIAC & VASCULAR PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:317-847-1427
Mailing Address - Street 1:8825 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1936
Mailing Address - Country:US
Mailing Address - Phone:317-352-1970
Mailing Address - Fax:317-352-1990
Practice Address - Street 1:11530 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2828
Practice Address - Country:US
Practice Address - Phone:317-859-3095
Practice Address - Fax:317-859-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RC0000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000376909OtherANTHEM BCBS
IN01040595BOtherCSR REF CARD
IN01040595AOtherPHYSICIAN LISC
IN01040595BOtherCSR REF CARD
IN01040595AOtherPHYSICIAN LISC