Organization
CEREBROCARE OF INDIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE BALLET (EXECUTIVE VP)
(860) 771-0622
Entity
Organization
Contact information
Practice address
130 PROFESSIONAL CT, LAFAYETTE, IN 47905-5153
(219) 588-8000
Mailing address
34 WELLS DR, FARMINGTON, CT 06032-3104
(860) 771-0622
(606) 402-2132
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
05/17/2023
Last updated
08/11/2023
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