Provider Demographics
NPI:1154399483
Name:SIDOR, TIM A (MD)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:A
Last Name:SIDOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6900 PEARL ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3639
Mailing Address - Country:US
Mailing Address - Phone:440-845-0900
Mailing Address - Fax:440-845-7355
Practice Address - Street 1:6681 RIDGE RD STE 411
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5705
Practice Address - Country:US
Practice Address - Phone:440-446-8637
Practice Address - Fax:216-201-8597
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2024-10-24
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Provider Licenses
StateLicense IDTaxonomies
OH35041262S208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489467Medicaid
C02331Medicare UPIN
OH0489467Medicaid