Healthcare Provider Details

I. General information

NPI: 1093643785
Provider Name (Legal Business Name): MR. BREONE L DUPREE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 S MERIDIAN ST STE 6
INDIANAPOLIS IN
46217-3310
US

IV. Provider business mailing address

4040 S MERIDIAN ST STE 6
INDIANAPOLIS IN
46217-3310
US

V. Phone/Fax

Practice location:
  • Phone: 317-758-8854
  • Fax:
Mailing address:
  • Phone: 317-758-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT22207650
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: