MEDICARE: DR. DEEPTAZ KAUR SIBIA DO

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	207P00000X	Emergency Medicine Physician	9762	AZ
2	208D00000X	General Practice Physician	OS9762	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760473458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPTAZ KAUR SIBIA DO

Provider Business Mailing Address
First Line	:	11269 MISTY RIDGE WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4895
Country	:	US
Telephone Number	:	561-301-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 GLADES RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6424
Country	:	US
Telephone Number	:	561-297-3512
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	09/18/2024

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