MEDICARE: DR. DARA D SPEARMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	01076018A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS084294	OTHER	MI	STATE LICENSE
2	01076018A	OTHER	IN	MEDICAL LICENSE
3	54947	OTHER	WI	DEPARTMENT OF REGULATION AND LICENSING

General Provider Information

NPI Number	:	1588783419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARA D SPEARMAN MD

Provider Business Mailing Address
First Line	:	722 E TILL RD # 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2066
Country	:	US
Telephone Number	:	260-487-4065
Fax Number	:	260-918-8369

Provider Business Practice Location Address
First Line	:	722 E TILL RD # 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2066
Country	:	US
Telephone Number	:	260-487-4065
Fax Number	:	260-918-8369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	05/01/2025

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