Provider Demographics
NPI:1083903678
Name:SIDDIQUI, FAISAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:M
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 1:1000 LOCUST ST
Mailing Address - Street 2:DEPT. OF INTERNAL MEDICINE
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2597
Mailing Address - Country:US
Mailing Address - Phone:775-328-1429
Mailing Address - Fax:775-337-2271
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:DEPT. OF INTERNAL MEDICINE
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1429
Practice Address - Fax:775-337-2271
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18704207RP1001X, 207RC0200X
VA0101255911207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083903678Medicaid