Provider Demographics
NPI:1386639904
Name:SIDDIQI, KHIZER M (MD)
Entity Type:Individual
Prefix:
First Name:KHIZER
Middle Name:M
Last Name:SIDDIQI
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 1:150 PARK CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:205-981-2152
Mailing Address - Fax:
Practice Address - Street 1:150 PARK CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:205-981-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017547207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520970OtherBCBS
AL5678710OtherAETNA
AL051520970Medicaid
AL051529063OtherBCBS
AL051520970OtherBCBS
AL051529063OtherBCBS
AL051529063Medicare ID - Type Unspecified
AL051520970Medicare PIN