Organization
ST. CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANWALDEEP SIDHU MD (MD)
(586) 552-4571
Entity
Organization
Contact information
Practice address
23829 LITTLE MACK AVE STE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
Mailing address
23829 LITTLE MACK AVE STE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E02122
BCBS PIN
MI
01
—
0E05556
BCBS DME PIN
MI
Enumeration date
09/19/2017
Last updated
07/21/2022
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