Provider Demographics
NPI:1124169685
Name:SIDHWA, KAMO G (MD)
Entity type:Individual
Prefix:
First Name:KAMO
Middle Name:G
Last Name:SIDHWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-654-4253
Practice Address - Street 1:13755 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1824
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:630-654-4253
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-113403207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113403Medicaid
ILK39950Medicare PIN
ILK39948Medicare PIN
ILK39949Medicare PIN