Basic Information
| Provider Information | |||||||||
| NPI: | 1760473458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIBIA | ||||||||
| FirstName: | DEEPTAZ | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17825 FIELDBROOK CIR W | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334961528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802520147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6401 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547768500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4238 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 275004000 | 05 | FL | MEDICAID | 947145 | 05 | AZ | MEDICAID |