Healthcare Provider Details

I. General information

NPI: 1114417599
Provider Name (Legal Business Name): SEAN MCGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 E STOP 11 RD STE 450
INDIANAPOLIS IN
46237-6342
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1800
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-4800
  • Fax: 317-865-4806
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01085666A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: