Provider Demographics
NPI:1831997220
Name:SIDHU, MANJINDER KAUR (NP)
Entity type:Individual
Prefix:
First Name:MANJINDER
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6232
Mailing Address - Country:US
Mailing Address - Phone:312-888-5509
Mailing Address - Fax:
Practice Address - Street 1:801 VILLA ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-8001
Practice Address - Country:US
Practice Address - Phone:708-350-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine