Provider Demographics
NPI:1336115450
Name:SIDDIQUI, ANWER H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWER
Middle Name:H
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1512
Mailing Address - Fax:859-331-3698
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-344-1512
Practice Address - Fax:859-331-3698
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068920207R00000X, 207RI0200X
KY57899207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200314710Medicaid
OH110222060OtherRR MEDICARE
OH2181080Medicaid
KY7100415040Medicaid
OH4017011Medicare PIN
IN200314710Medicaid
OHG24720Medicare UPIN
OH110222060OtherRR MEDICARE