Provider Demographics
NPI:1386669760
Name:SIDDIQUI, SABIHA T (MD)
Entity Type:Individual
Prefix:DR
First Name:SABIHA
Middle Name:T
Last Name:SIDDIQUI
Suffix:
Gender:F
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:# L3571
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:937-885-3206
Mailing Address - Fax:
Practice Address - Street 1:224 S WOODS MILL RD STE 570
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3513
Practice Address - Country:US
Practice Address - Phone:314-205-6898
Practice Address - Fax:314-590-5911
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019036727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2653669Medicaid
OHSI4181111Medicare ID - Type UnspecifiedMEDICARE ID
OH2653669Medicaid