Provider Demographics
NPI:1508211384
Name:SIDDIQUI, ZARA MUSTAJAB (DO)
Entity Type:Individual
Prefix:
First Name:ZARA
Middle Name:MUSTAJAB
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4757 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4559
Mailing Address - Country:US
Mailing Address - Phone:812-234-2289
Mailing Address - Fax:812-232-4234
Practice Address - Street 1:4757 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4559
Practice Address - Country:US
Practice Address - Phone:812-234-2289
Practice Address - Fax:812-232-4234
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02006549A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine