Provider Demographics
NPI:1003487018
Name:SIDDIQI, IMRAN AHMED (DO)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:AHMED
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13162 58TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-4601
Mailing Address - Country:US
Mailing Address - Phone:847-714-6145
Mailing Address - Fax:
Practice Address - Street 1:26520 CACTUS AVE.
Practice Address - Street 2:RUHS-MC ED BLDG RM. 339
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-486-5912
Practice Address - Fax:951-486-5910
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program