MEDICARE: BROAD RIPPLE PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician

General Provider Information

NPI Number	:	1962381376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD RIPPLE PEDIATRICS

Provider Business Mailing Address
First Line	:	6527 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1664
Country	:	US
Telephone Number	:	317-875-0009
Fax Number	:	317-875-3993

Provider Business Practice Location Address
First Line	:	6527 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1664
Country	:	US
Telephone Number	:	317-875-0009
Fax Number	:	317-875-3993

Authorized Official
Title or Position	:	DOCTOR
Name	:	GARY HALBERSTADT
Credential	:	DO
Telephone Number	:	317-875-0009

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

Similar Medicare Providers

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Practice Location Address:

6527 CARROLLTON AVE
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1699656108 — BROAD RIPPLE PEDIATRICS, LLC
Practice Location Address:

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1871654699 — JEFFREY M. CANFIELD D.D.S.
Practice Location Address:

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1275791709 — DR. SHADRACH G GONQUEH DDS
Practice Location Address:

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1144108127 — SHEMIA ALLEN
Practice Location Address:

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Directions to “BROAD RIPPLE PEDIATRICS ” Practice Location

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