Provider Demographics
NPI:1982759288
Name:SIDELL, PHILIP ALDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALDEN
Last Name:SIDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3920 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1211
Mailing Address - Country:US
Mailing Address - Phone:952-926-3002
Mailing Address - Fax:952-926-7744
Practice Address - Street 1:3920 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1211
Practice Address - Country:US
Practice Address - Phone:952-926-3002
Practice Address - Fax:952-926-7744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31011208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95189Medicare UPIN