Provider Demographics
NPI:1518751585
Name:HARNETIAUX, SIDNEY (PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:HARNETIAUX
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 RED BALL TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2752
Mailing Address - Country:US
Mailing Address - Phone:618-534-1767
Mailing Address - Fax:
Practice Address - Street 1:390 OFFICE CT
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2059
Practice Address - Country:US
Practice Address - Phone:618-233-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085011197OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION