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General NPI Number Information
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NPI Number | 1851813489
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Entity Type | Individual
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Provider Name | SIDDHANTH AHLUWALIA MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 3003 UNIVERSITY DR
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City | MARINETTE
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State | WI
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Zip | 54143-4110
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Country | US
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Telephone | 715-735-4200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD-47850
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125.073242
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301112146
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 84576-20
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License Number State | WI
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