Provider Demographics
NPI:1376698936
Name:SIDDIQUI, YUSUF MOHAMED (MD FACS)
Entity Type:Individual
Prefix:MR
First Name:YUSUF
Middle Name:MOHAMED
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2634
Mailing Address - Country:US
Mailing Address - Phone:716-838-8488
Mailing Address - Fax:716-838-3022
Practice Address - Street 1:2178 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2634
Practice Address - Country:US
Practice Address - Phone:716-838-8488
Practice Address - Fax:716-838-3022
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136544208600000X, 208D00000X
MO35630208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00746901Medicaid
000508766003OtherCB BLUE CROSS
0010165801OtherUNIVERA
NY00746901Medicaid
087663Medicare ID - Type Unspecified