Provider Demographics
NPI:1871608356
Name:IBRIC, JEAN A (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:IBRIC
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 1:1010 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-1500
Mailing Address - Country:US
Mailing Address - Phone:608-741-2430
Mailing Address - Fax:608-741-6798
Practice Address - Street 1:1010 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1500
Practice Address - Country:US
Practice Address - Phone:608-741-2430
Practice Address - Fax:608-741-6798
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIIBRICJEAOtherMERCYCARE INSURANCE
WI31836300Medicaid
WIBM2441878OtherDEA LICENSE
WI73840-0271Medicare ID - Type Unspecified
WIIBRICJEAOtherMERCYCARE INSURANCE
WI541760749Medicare PIN