Provider Demographics
NPI:1093807703
Name:GICHERU, SIDNEY K (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:K
Last Name:GICHERU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:440 W HWY 635
Mailing Address - Street 2:SUITE 300 PLAZA II
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:214-574-9600
Mailing Address - Fax:214-574-9601
Practice Address - Street 1:440 W LBJ FREEWAY
Practice Address - Street 2:SUITE 300 PLAZA II
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:214-574-9600
Practice Address - Fax:214-574-9601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8626207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7112157OtherAETNA HEALTHCARE
TX0311623-01Medicaid
TXH21318Medicare UPIN
TX00216UMedicare ID - Type UnspecifiedGROUP #
TX0311623-01Medicaid