Healthcare Provider Details

I. General information

NPI: 1710160817
Provider Name (Legal Business Name): JUHEE SIDHU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE
ALBUQUERQUE NM
87109-4495
US

IV. Provider business mailing address

4901 LANG AVE NE
ALBUQUERQUE NM
87109-4495
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-8171
  • Fax:
Mailing address:
  • Phone: 505-842-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2012-0404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: