Provider Demographics
NPI:1003858275
Name:SIDDIQUI, MOHAMMAD T (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:T
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-0507
Practice Address - Street 1:1101 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-0507
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17468207RN0300X
FLME98002207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2191106OtherUNITED HEALTHCARE
FL94661OtherBC/BS
FL7280103OtherAETNA
FL7280103OtherAETNA
FLAC951YMedicare PIN
FL94661OtherBC/BS