Healthcare Provider Details

I. General information

NPI: 1710139902
Provider Name (Legal Business Name): RUHEE SIDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N HARLEM AVE
FREEPORT IL
61032-3801
US

IV. Provider business mailing address

421 W EXCHANGE ST PO BOX 268
FREEPORT IL
61032-0268
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-7750
  • Fax: 815-599-7546
Mailing address:
  • Phone: 815-599-7950
  • Fax: 815-599-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301093135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: