Provider Demographics
NPI:1447217542
Name:SIDDIQI, BUSHRA N (MD)
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:N
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4040
Mailing Address - Fax:614-293-3277
Practice Address - Street 1:500 THOMAS LN STE A1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1419
Practice Address - Country:US
Practice Address - Phone:614-566-2300
Practice Address - Fax:614-533-0353
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35080416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2287305Medicaid
OHSI4065152Medicare PIN
H53345Medicare UPIN