Provider Demographics
NPI:1497000194
Name:ANWAR, SIDDIQ (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SIDDIQ
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 THE BOULEVARD SAINT LOUIS
Mailing Address - Street 2:# 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1123
Mailing Address - Country:US
Mailing Address - Phone:314-475-4754
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE # 8129
Practice Address - Street 2:RENAL FELLOWSHIP PROGRAM
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-7211
Practice Address - Fax:314-747-3743
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012021715207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology