Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD456181 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD456181 | PA |
NPI | 1235496340 |
---|---|
Provider Name | Dr. Michael M Sidhom |
First Address | Bethlehem, PA 18017 |
Second Address | Bethlehem, PA 18017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 02/11/2016 |