Provider Demographics
NPI:1457662439
Name:MUHAMMAD M SIDDIQUI MD PA
Entity Type:Organization
Organization Name:MUHAMMAD M SIDDIQUI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-664-4349
Mailing Address - Street 1:937 BAREFOOT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BAREFOOT BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7654
Mailing Address - Country:US
Mailing Address - Phone:772-664-4349
Mailing Address - Fax:772-664-4818
Practice Address - Street 1:937 BAREFOOT BLVD STE A
Practice Address - Street 2:
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7654
Practice Address - Country:US
Practice Address - Phone:772-664-4349
Practice Address - Fax:772-664-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023240207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055307700Medicaid
FLD54201Medicare UPIN
FLDE546AMedicare PIN