Provider Demographics
NPI:1407967060
Name:A.S.F. SIDDIQUI, M.D., LTD.
Entity Type:Organization
Organization Name:A.S.F. SIDDIQUI, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-921-6823
Mailing Address - Street 1:3540 W SAHARA AVE # 330
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:702-921-6823
Mailing Address - Fax:702-549-5240
Practice Address - Street 1:9300 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4844
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-549-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV110236074OtherRAILROAD CARRIER
NV20-02406Medicaid
NV110236074OtherRAILROAD CARRIER
NVV32087Medicare PIN