Provider Demographics
NPI:1538265400
Name:SIDHU, KIRPAL S (MD)
Entity type:Individual
Prefix:DR
First Name:KIRPAL
Middle Name:S
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRPAL
Other - Middle Name:S
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29 EULA GRAY STREET
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831
Mailing Address - Country:US
Mailing Address - Phone:606-573-9690
Mailing Address - Fax:606-573-9692
Practice Address - Street 1:29 EULA GRAY STREET
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831
Practice Address - Country:US
Practice Address - Phone:606-573-9690
Practice Address - Fax:606-573-9692
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010196591OtherVIRGINIA
KYG4103336Medicaid
010196591OtherVIRGINIA
1963701Medicare ID - Type Unspecified