Individual
DR. KANWALDEEP S SIDHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23829 LITTLE MACK AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
(586) 773-1600
Mailing address
23829 LITTLE MACK AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
(586) 773-1600
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
KS054699
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0826968
BLUE CROSS BLUE SHIELD
MI
05
—
3164740
—
MI
01
—
C4763
MCARE
MI
Enumeration date
04/04/2006
Last updated
11/27/2012
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