Provider Demographics
NPI:1700866365
Name:SIDHU, MAHTAB K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:K
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:SUITE N240A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-874-4763
Practice Address - Fax:414-874-4160
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI45476-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34373900Medicaid
WI34373900Medicaid
WIH86011Medicare UPIN