Provider Demographics
NPI:1265458939
Name:SIDDIQUI, MUSSARAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSSARAT
Middle Name:
Last Name:SIDDIQUI
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 1:4250 ALAFAYA TRL STE 212
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9424
Mailing Address - Country:US
Mailing Address - Phone:407-558-8504
Mailing Address - Fax:
Practice Address - Street 1:4250 ALAFAYA TRL STE 212
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9424
Practice Address - Country:US
Practice Address - Phone:407-558-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45934207L00000X
GA027249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00001971OtherRAILROAD MEDICARE
FL47688OtherBCBS
FLC58239Medicare UPIN
FLK2958Medicare ID - Type UnspecifiedMEDICARE GROUP
FL47688OtherBCBS