Provider Demographics
NPI:1508977067
Name:SIDHU, GURSHARAN KAUR (MD)
Entity Type:Individual
Prefix:
First Name:GURSHARAN
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 EULA GRAY ST
Mailing Address - Street 2:GURSHARAN KAUR SIDHU MD
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831
Mailing Address - Country:US
Mailing Address - Phone:606-573-9690
Mailing Address - Fax:606-573-9692
Practice Address - Street 1:29 EULA GRAY ST
Practice Address - Street 2:GURSHARAN KAUR SIDHU MD
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831
Practice Address - Country:US
Practice Address - Phone:606-573-9690
Practice Address - Fax:606-573-9692
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40039208000000X
OH35071449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0538672Medicaid