Provider Demographics
NPI:1235138082
Name:SIDKY, ADEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:M
Last Name:SIDKY
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 1:323 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7234
Mailing Address - Country:US
Mailing Address - Phone:561-737-1818
Mailing Address - Fax:531-737-5108
Practice Address - Street 1:323 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7234
Practice Address - Country:US
Practice Address - Phone:561-737-1818
Practice Address - Fax:531-737-5108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44829207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63981Medicare UPIN
96755ZMedicare ID - Type Unspecified