MEDICARE: AMRIK SINGH SIDHU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A36952	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073618500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMRIK SINGH SIDHU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1434
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-1434
Country	:	US
Telephone Number	:	209-462-7277
Fax Number	:	866-950-0134

Provider Business Practice Location Address
First Line	:	1503 E MARCH LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-5622
Country	:	US
Telephone Number	:	209-462-7277
Fax Number	:	866-950-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	01/12/2022

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