Provider Demographics
NPI:1366426850
Name:HARRIS BROMUND, HEIDI LYNN (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:HARRIS BROMUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 NAAB RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8424 NAAB RD STE 2A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1966
Practice Address - Country:US
Practice Address - Phone:317-415-6300
Practice Address - Fax:317-415-6303
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044151A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200148310Medicaid
IN940550MMMedicare PIN
IN200148310Medicaid