Provider Demographics
NPI:1235157421
Name:SIDDIQI, TARIQ A (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:A
Last Name:SIDDIQI
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 1:755 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1442
Mailing Address - Country:US
Mailing Address - Phone:517-265-2175
Mailing Address - Fax:517-264-5926
Practice Address - Street 1:755 HIGH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1442
Practice Address - Country:US
Practice Address - Phone:517-265-2175
Practice Address - Fax:517-264-5926
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS069384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG58342Medicare UPIN