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General NPI Number Information
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NPI Number | 1033326947
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Entity Type | Individual
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Provider Name | KANWALDEEP SIDHU MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/15/2022
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Provider Practice Location Address
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Address Line | 10765 LANTERN ROAD SUITE 102
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City | FISHERS
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State | IN
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Zip | 46038-3597
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Country | US
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Telephone | 317-621-4181
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Fax | 317-621-4182
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Provider Business Mailing Address
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Address Line | 10765 LANTERN ROAD SUITE 102
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City | FISHERS
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State | IN
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Zip | 46038-3597
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Country | US
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Telephone | 317-621-4181
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Fax | 317-621-4182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01066327 A
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License Number State | IN
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