Provider Demographics
NPI:1235380593
Name:SIDDIQUE, AFSHEEN (MD)
Entity Type:Individual
Prefix:
First Name:AFSHEEN
Middle Name:
Last Name:SIDDIQUE
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 1:3650 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5753
Mailing Address - Country:US
Mailing Address - Phone:228-875-0780
Mailing Address - Fax:228-875-1009
Practice Address - Street 1:3650 GROVELAND RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5753
Practice Address - Country:US
Practice Address - Phone:228-875-0780
Practice Address - Fax:228-875-1009
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07372301Medicaid
MS20414OtherMISSISSIPPI MEDICAL LICENSE