Provider Demographics
NPI:1104315316
Name:SIDOR, ALEXANDER MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:SIDOR
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 1:35 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1850
Mailing Address - Country:US
Mailing Address - Phone:484-574-7638
Mailing Address - Fax:
Practice Address - Street 1:1417 LAKELAND HILLS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3200
Practice Address - Country:US
Practice Address - Phone:863-577-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1460572085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology