Organization
CANCER CARE CONSULTANTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BALAGOPAL KERALAVARMA MD (OWNER)
(219) 742-4237
Entity
Organization
Contact information
Practice address
8554 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 750-9581
(219) 750-9781
Mailing address
8554 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 750-9581
(219) 750-9781
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01052677A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201001720A
—
IN
01
—
90001550
BSIL
IL
Enumeration date
10/14/2009
Last updated
01/13/2022
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