Provider Demographics
NPI:1003386772
Name:SIDDIQUI, MUHAMMAD SUHAIL (RPT)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SUHAIL
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 NORTHCOTE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4006
Mailing Address - Country:US
Mailing Address - Phone:248-722-7473
Mailing Address - Fax:248-289-4691
Practice Address - Street 1:5575 NORTHCOTE
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4006
Practice Address - Country:US
Practice Address - Phone:248-722-7473
Practice Address - Fax:248-289-4691
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist