Provider Demographics
NPI:1639326788
Name:SIDAK, CAMERON L (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:L
Last Name:SIDAK
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 1:531 BEEBE ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:NE
Mailing Address - Zip Code:68651-5537
Mailing Address - Country:US
Mailing Address - Phone:402-747-8851
Mailing Address - Fax:
Practice Address - Street 1:531 BEEBE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:NE
Practice Address - Zip Code:68651
Practice Address - Country:US
Practice Address - Phone:402-747-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24813207Q00000X
NE5577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine