Provider Demographics
NPI:1164409496
Name:SIDDIQUI, SAADIA VAQAR (MD)
Entity Type:Individual
Prefix:
First Name:SAADIA
Middle Name:VAQAR
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18161 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3219
Mailing Address - Country:US
Mailing Address - Phone:586-772-7200
Mailing Address - Fax:586-772-7207
Practice Address - Street 1:18161 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3219
Practice Address - Country:US
Practice Address - Phone:586-772-7200
Practice Address - Fax:586-772-7207
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05828314OtherECFMG
MI4573540Medicaid
53150011798OtherCONTROLLED SUBSTANCE
53150011798OtherCONTROLLED SUBSTANCE
BS8044163OtherDEA
H77778Medicare UPIN