Healthcare Provider Details

I. General information

NPI: 1225003668
Provider Name (Legal Business Name): HARINDER KAUR SIDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 E MICHIGAN ST
ORLANDO FL
32806-5041
US

IV. Provider business mailing address

2611 E MICHIGAN ST
ORLANDO FL
32806-5041
US

V. Phone/Fax

Practice location:
  • Phone: 407-897-1100
  • Fax: 407-897-1160
Mailing address:
  • Phone: 407-897-1100
  • Fax: 407-897-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME0058803
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0058803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: