Provider Demographics
NPI:1043456387
Name:SIDDIQ, DANISH MUMTAZ (MD)
Entity Type:Individual
Prefix:
First Name:DANISH
Middle Name:MUMTAZ
Last Name:SIDDIQ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:137-780-2888
Mailing Address - Fax:813-355-5041
Practice Address - Street 1:2740 WINDGUARD CIR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7363
Practice Address - Country:US
Practice Address - Phone:137-780-2888
Practice Address - Fax:133-555-0418
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 115965207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14QF4OtherBCBS
FL009510500Medicaid
FLP01288905OtherRAILROAD MEDICARE