Provider Demographics
NPI:1598200198
Name:ASHA PRITPAL SINGH SIDHU MD INC
Entity Type:Organization
Organization Name:ASHA PRITPAL SINGH SIDHU MD INC
Other - Org Name:FRESNO LONG TERM CARE MEDICAL GROUP INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA PRITPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-222-6500
Mailing Address - Street 1:5771 N FRESNO ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6091
Mailing Address - Country:US
Mailing Address - Phone:559-222-6500
Mailing Address - Fax:559-222-6555
Practice Address - Street 1:5771 N FRESNO ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6091
Practice Address - Country:US
Practice Address - Phone:559-222-6500
Practice Address - Fax:559-222-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty