Provider Demographics
NPI:1942459664
Name:GARREAN, SEAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:GARREAN
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 E MAUMEE ST STE 201
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2035
Practice Address - Country:US
Practice Address - Phone:260-266-5300
Practice Address - Fax:260-266-5314
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115199208600000X
IN01069614A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201022370Medicaid
IN000000714660OtherANTHEM
OH0062893Medicaid
INM400049689Medicare PIN