Provider Demographics
NPI:1376763557
Name:MALWINDER SIDHU MD PC
Entity Type:Organization
Organization Name:MALWINDER SIDHU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-798-3008
Mailing Address - Street 1:PO BOX 50223
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0223
Mailing Address - Country:US
Mailing Address - Phone:702-798-3008
Mailing Address - Fax:702-869-4763
Practice Address - Street 1:5735 S FORT APACHE RD
Practice Address - Street 2:B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-0223
Practice Address - Country:US
Practice Address - Phone:702-798-3008
Practice Address - Fax:702-869-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036AHMedicare ID - Type Unspecified