MEDICARE: MS. HARINDER KAUR SIDHU 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	ME0058803	FL
2	2084N0400X	Neurology Physician	ME0058803	FL

General Provider Information

NPI Number	:	1225003668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HARINDER KAUR SIDHU MD

Provider Business Mailing Address
First Line	:	2611 E MICHIGAN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-5041
Country	:	US
Telephone Number	:	407-897-1100
Fax Number	:	407-897-1160

Provider Business Practice Location Address
First Line	:	2611 E MICHIGAN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-5041
Country	:	US
Telephone Number	:	407-897-1100
Fax Number	:	407-897-1160

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	02/07/2008

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