Healthcare Provider Details

I. General information

NPI: 1326296369
Provider Name (Legal Business Name): ADAM SIDKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR ROOM R144
PALO ALTO CA
94305-2200
US

IV. Provider business mailing address

3782 CORINA WAY
PALO ALTO CA
94303-4504
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-5903
  • Fax: 650-724-3044
Mailing address:
  • Phone: 650-815-9794
  • Fax: 650-724-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA105358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: