Provider Demographics
NPI:1902885924
Name:SIDHU, HARJOT (MD)
Entity type:Individual
Prefix:
First Name:HARJOT
Middle Name:
Last Name:SIDHU
Suffix:
Gender:
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:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-329-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47457207R00000X, 207RG0100X
CAC54946207RG0100X
WI38593207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040933200Medicaid
MN132592OtherUCARE
41084933956001C005OtherCHAMPUS
MNNA2951042895OtherPREFFERED ONE
MN944S8SIOtherBCBS
MN2316540OtherAMERICAS PPO
IA2450023OtherMEDICAID
MN2900368OtherMEDICA
WI32507300Medicaid
MNHP49006OtherHEALTH PARTNERS
MN040933200Medicaid
MN100000620Medicare Oscar/Certification