Provider Demographics
NPI:1073618500
Name:SIDHU, AMRIK SINGH (MD)
Entity Type:Individual
Prefix:
First Name:AMRIK
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1434
Mailing Address - Country:US
Mailing Address - Phone:209-462-7277
Mailing Address - Fax:866-950-0134
Practice Address - Street 1:1503 E MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5622
Practice Address - Country:US
Practice Address - Phone:209-462-7277
Practice Address - Fax:866-950-0134
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A369520Medicaid
CA00A369520Medicare ID - Type Unspecified
CA00A369520Medicaid