Individual
JUAN M IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1045 W STEPHENSON ST, FREEPORT, IL 61032-4864
(815) 599-6159
Mailing address
2830 MARVIN LN, FREEPORT, IL 61032-9315
(815) 235-7093
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036082621
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036082621
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08932005
BCBS OF IL PROVIDER NBR
IL
01
—
720000238
RAILROAD MEDICARE NUMBER
IL
Enumeration date
04/04/2007
Last updated
01/10/2025
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