Provider Demographics
NPI:1033326947
Name:SIDHU, KANWALDEEP (MD)
Entity type:Individual
Prefix:
First Name:KANWALDEEP
Middle Name:
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10765 LANTERN ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3597
Mailing Address - Country:US
Mailing Address - Phone:317-621-4181
Mailing Address - Fax:317-621-4182
Practice Address - Street 1:10765 LANTERN ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3597
Practice Address - Country:US
Practice Address - Phone:317-621-4181
Practice Address - Fax:317-621-4182
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066327 A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000691248OtherANTHEM
IN000000721380OtherANTHEM
IN200944150Medicaid
IN000000637200OtherANTHEM
IN9676336OtherAETNA
IN000000684780OtherANTHEM
INP01191777OtherRR MEDICARE PTAN
ININ2504006Medicare PIN
IN165490LLLMedicare PIN
IN258800FMedicare PIN
INM400063256Medicare PIN
IN000000691248OtherANTHEM
INM400037596Medicare PIN