Provider Demographics
NPI:1073802286
Name:SIDDHARTHAN, TRISHUL (MD)
Entity Type:Individual
Prefix:
First Name:TRISHUL
Middle Name:
Last Name:SIDDHARTHAN
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 1:1450 NW 10TH AVE STE 1101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1011
Mailing Address - Country:US
Mailing Address - Phone:305-243-6387
Mailing Address - Fax:305-243-6372
Practice Address - Street 1:1450 NW 10TH AVE STE 1101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1011
Practice Address - Country:US
Practice Address - Phone:305-243-6387
Practice Address - Fax:305-243-6372
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD80049207R00000X, 207RP1001X
FLME147348207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine