Provider Demographics
NPI:1104823079
Name:SIDDIQI, NASEEMUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:NASEEMUL
Middle Name:H
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NASEEM
Other - Middle Name:H
Other - Last Name:SIDDIQI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-637-5186
Mailing Address - Fax:865-637-8487
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-637-5186
Practice Address - Fax:865-637-8487
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163481Medicaid
TNBO3009Medicare UPIN
TN3163481Medicaid