Provider Demographics
NPI:1336107184
Name:SIDDIQUE, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:SIDDIQUE
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 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 301-B
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5777
Mailing Address - Country:US
Mailing Address - Phone:256-320-5405
Mailing Address - Fax:256-320-5407
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 301-B
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-320-5405
Practice Address - Fax:256-320-5407
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940774Medicaid
AL51538761OtherBCBS
AL51538761OtherBCBS
H07803Medicare UPIN