MEDICARE: DR. LOVLEEN SIDHU

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	1223G0001X	General Practice Dentistry	6001229-15	WI

General Provider Information

NPI Number	:	1750068961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOVLEEN SIDHU

Provider Business Mailing Address
First Line	:	1437 N JEFFERSON ST APT 111
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2995
Country	:	US
Telephone Number	:	516-737-6738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 N JEFFERSON ST APT 111
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2995
Country	:	US
Telephone Number	:	516-737-6738
Fax Number	:

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

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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