Provider Demographics
NPI:1225234164
Name:BILAL, SIDDEEQAH (MD)
Entity Type:Individual
Prefix:
First Name:SIDDEEQAH
Middle Name:
Last Name:BILAL
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:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-0463
Mailing Address - Country:US
Mailing Address - Phone:601-291-5951
Mailing Address - Fax:601-602-3353
Practice Address - Street 1:205 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2819
Practice Address - Country:US
Practice Address - Phone:601-783-2351
Practice Address - Fax:601-783-5681
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-19632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00178228Medicaid