Provider Demographics
NPI:1427022052
Name:SIDDIQUI, FARRUKH A (MD)
Entity Type:Individual
Prefix:
First Name:FARRUKH
Middle Name:A
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 1:501 20TH ST
Mailing Address - Street 2:STE 303
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1809
Mailing Address - Country:US
Mailing Address - Phone:865-541-1375
Mailing Address - Fax:865-541-1714
Practice Address - Street 1:501 20TH ST
Practice Address - Street 2:STE 303
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1809
Practice Address - Country:US
Practice Address - Phone:865-541-1375
Practice Address - Fax:865-541-1714
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32071207Q00000X, 207QS1201X, 208M00000X
TXM2807207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338504901Medicaid
TX8EL099OtherBCBS
TXP01379269OtherRAILROAD MEDICARE
4038752OtherBCBST
TN3855235Medicaid
TN103I080271Medicare PIN
TX8EL099OtherBCBS
4038752OtherBCBST
TX359455YPF6Medicare PIN
TN080187587Medicare PIN