Organization
CARDIAC & VASCULAR PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELMER PANTE MANALO M.D. (PRESIDENT)
(317) 847-1427
Entity
Organization
Contact information
Practice address
11530 E WASHINGTON ST, INDIANAPOLIS, IN 46229-2828
(317) 859-3095
(317) 859-3098
Mailing address
8825 E 21ST ST, INDIANAPOLIS, IN 46219-1936
(317) 352-1970
(317) 352-1990
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207RC0000X
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376909
ANTHEM BCBS
IN
01
—
01040595A
PHYSICIAN LISC
IN
01
—
01040595B
CSR REF CARD
IN
Enumeration date
12/14/2006
Last updated
08/22/2020
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