Provider Demographics
NPI:1003072760
Name:SIDDIQUI, MAHREEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHREEN
Middle Name:A
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAHREEN
Other - Middle Name:M
Other - Last Name:ALAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:1500 CONCORD TERRACE,
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3009
Mailing Address - Country:US
Mailing Address - Phone:954-384-0175
Mailing Address - Fax:954-851-1838
Practice Address - Street 1:1500 CONCORD TERRACE,
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3009
Practice Address - Country:US
Practice Address - Phone:954-384-0175
Practice Address - Fax:954-851-1838
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110342208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics