Provider Demographics
NPI:1487607875
Name:IBARRA, SHERMAN GAURANO (MD)
Entity type:Individual
Prefix:
First Name:SHERMAN
Middle Name:GAURANO
Last Name:IBARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3987
Practice Address - Country:US
Practice Address - Phone:765-747-3888
Practice Address - Fax:765-288-6139
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00250278OtherRAILROAD MEDICARE NUMBER
FL291761100Medicaid
IN201269000Medicaid
IN201269000Medicaid
FL37320VMedicare PIN
I00857Medicare UPIN
FL37320WMedicare PIN