| Cerebrocare Of Indiana, Llc | |
|
130 Professional Ct Lafayette IN 47905-5153 | |
| (219) 588-8000 | |
| Not Available |
| Full Name | Cerebrocare Of Indiana, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 130 Professional Ct, Lafayette, Indiana |
| Authorized Official Name and Position | Bruce Ballet (EXECUTIVE VP) |
| Authorized Official Contact | 8607710622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cerebrocare Of Indiana, Llc 34 Wells Dr Farmington CT 06032-3104 Ph: (860) 771-0622 | Cerebrocare Of Indiana, Llc 130 Professional Ct Lafayette IN 47905-5153 Ph: (219) 588-8000 |
| NPI Number | 1659062099 |
|---|---|
| Provider Enumeration Date | 05/17/2023 |
| Last Update Date | 08/11/2023 |
| Certification Date | 08/11/2023 |
| Medicare PECOS PAC ID | 1557721172 |
|---|---|
| Medicare Enrollment ID | O20230714000554 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659062099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 208VP0000X | Pain Medicine - Pain Medicine | (* (Not Available)) | Secondary |
| Provider Name | Julian Y Ungar-sargon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376642900 PECOS PAC ID: 4880593144 Enrollment ID: I20040106000222 |
| Provider Name | Bobby Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457891806 PECOS PAC ID: 1759650963 Enrollment ID: I20190521003514 |
| Provider Name | Merinda Barbara Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255895199 PECOS PAC ID: 9931438348 Enrollment ID: I20210823001831 |
| Provider Name | George Abraham Khouri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609138866 PECOS PAC ID: 4587987268 Enrollment ID: I20230623001514 |
| Provider Name | Lorie Ann Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679097588 PECOS PAC ID: 8921374026 Enrollment ID: I20240112000321 |
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