Provider Demographics
NPI:1245514595
Name:SIDUS MEDICAL CORPORATION
Entity type:Organization
Organization Name:SIDUS MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-577-9500
Mailing Address - Street 1:1041 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3728
Mailing Address - Country:US
Mailing Address - Phone:714-577-9500
Mailing Address - Fax:714-577-9504
Practice Address - Street 1:1041 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3728
Practice Address - Country:US
Practice Address - Phone:714-577-9500
Practice Address - Fax:714-577-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty