Healthcare Provider Details

I. General information

NPI: 1508977067
Provider Name (Legal Business Name): GURSHARAN KAUR SIDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EULA GRAY ST GURSHARAN KAUR SIDHU MD
HARLAN KY
40831
US

IV. Provider business mailing address

29 EULA GRAY ST GURSHARAN KAUR SIDHU MD
HARLAN KY
40831
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-9690
  • Fax: 606-573-9692
Mailing address:
  • Phone: 606-573-9690
  • Fax: 606-573-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40039
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35071449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: