Individual
JASMINE KAUR SIDHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-7624
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02004999A
IN
207R00000X
Internal Medicine Physician
25MB09276100
NJ
207R00000X
Internal Medicine Physician
269906
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001107048
ANTHEM PROVIDER NUMBER
IN
05
—
03648368
—
NY
05
—
300006662
—
IN
01
—
815500236
MEDICARE PTAN
IN
01
—
P02094231
RAILROAD PTAN
IN
Enumeration date
06/03/2013
Last updated
12/29/2023
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