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General NPI Number Information
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NPI Number | 1215952601
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Entity Type | Individual
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Provider Name | SALLY J SIDMAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 1206 E. NATIONAL AVENUE
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City | BRAZIL
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State | IN
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Zip | 47834
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Country | US
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Telephone | 812-442-2700
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Fax | 812-442-2710
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Provider Business Mailing Address
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Address Line | 1206 E. NATIONAL AVENUE
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City | BRAZIL
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State | IN
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Zip | 47834
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Country | US
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Telephone | 812-442-2700
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Fax | 812-442-2710
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-098644
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01042578A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G74927
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License Number State | CA
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