Individual
SALLY J SIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1206 E. NATIONAL AVENUE, BRAZIL, IN 47834
(812) 442-2700
(812) 442-2710
Mailing address
1206 E. NATIONAL AVENUE, BRAZIL, IN 47834
(812) 442-2700
(812) 442-2710
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01042578A
IN
207P00000X
Emergency Medicine Physician
036-098644
IL
207P00000X
Emergency Medicine Physician
G74927
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000602172
BLUE SHIELD
IN
01
—
036098644
BLUE SHIELD
IL
05
—
036098644
—
IL
05
—
100381480
—
IN
Enumeration date
07/13/2006
Last updated
03/27/2014
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