Healthcare Provider Details

I. General information

NPI: 1265371785
Provider Name (Legal Business Name): MICAH BRONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N MOUNT ST
INDIANAPOLIS IN
46222-3151
US

IV. Provider business mailing address

4120 ANSAR LN
INDIANAPOLIS IN
46254-3123
US

V. Phone/Fax

Practice location:
  • Phone: 463-206-7760
  • Fax:
Mailing address:
  • Phone: 463-206-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: