Provider Demographics
NPI:1023570470
Name:GURSHARAN K SIDHU MD
Entity Type:Organization
Organization Name:GURSHARAN K SIDHU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GURSHARAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-573-9691
Mailing Address - Street 1:29 EULA GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1750
Mailing Address - Country:US
Mailing Address - Phone:606-573-9691
Mailing Address - Fax:606-573-9692
Practice Address - Street 1:29 EULA GRAY ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1750
Practice Address - Country:US
Practice Address - Phone:606-573-9691
Practice Address - Fax:606-573-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty