Provider Demographics
NPI:1700995586
Name:SIDI, SYLVAIN (MD)
Entity Type:Individual
Prefix:
First Name:SYLVAIN
Middle Name:
Last Name:SIDI
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:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-885-7600
Practice Address - Fax:520-885-7601
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08458207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ08458OtherMEDICAL LICENSE
AZ214099Medicaid
AZAZ0726920OtherBCBSAZ
AZAZ0726920OtherBCBSAZ
AZZ72822Medicare PIN