Individual
JASWANT S SIDHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948
(618) 942-2171
(618) 351-4917
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036083194
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083194-2
—
IL
05
—
036083194-4
—
IL
Enumeration date
05/04/2006
Last updated
09/28/2021
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