Provider Demographics
NPI:1174631758
Name:SIDDIQ, TAHIR (MD)
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:SIDDIQ
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 1:102 CONECUH AVE W
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-1303
Mailing Address - Country:US
Mailing Address - Phone:469-530-4932
Mailing Address - Fax:469-257-3501
Practice Address - Street 1:102 CONECUH AVE W
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1303
Practice Address - Country:US
Practice Address - Phone:334-738-2140
Practice Address - Fax:334-738-1511
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19681207P00000X, 207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034042Medicaid
110128435OtherRAILROAD MEDICARE
AL051034042OtherBCBS
AL051034042OtherBCBS
G34363Medicare UPIN