Doctor Name: | SHAWN SIDHARTHAN |
NPI Number: | 1356617997 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1775 Dempster St Park Ridge, IL - 600681143 |
Business Phone Number: | 9567392742 |
Business Fax Number: | |
Mailing Address: | 512 N Mcclurg Ct Apt 4612, CHICAGO |
State: | IL |
Postal Code: | 606114181 |
Phone Number: | 9567392742 |
Fax Number: | 3124679388 |
NPI Enumeration Date: | 03/28/2012 |
NPI Last Update Date: | 03/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |