Provider Demographics
NPI:1558306902
Name:SIDANI, TARIK (DO)
Entity Type:Individual
Prefix:
First Name:TARIK
Middle Name:
Last Name:SIDANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3539
Mailing Address - Country:US
Mailing Address - Phone:870-741-8289
Mailing Address - Fax:870-741-0308
Practice Address - Street 1:224 W ERIE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3539
Practice Address - Country:US
Practice Address - Phone:870-741-8289
Practice Address - Fax:870-741-0308
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5079207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI65811Medicare UPIN
AR5N847Medicare PIN