Provider Demographics
NPI:1528368701
Name:MUHAMMAD ALI SIDDIQUI, MD PA
Entity Type:Organization
Organization Name:MUHAMMAD ALI SIDDIQUI, MD PA
Other - Org Name:LAKEWOOD FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SIDDIQUI MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-975-3616
Mailing Address - Street 1:4701 FAIRWAY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8066
Mailing Address - Country:US
Mailing Address - Phone:501-975-3616
Mailing Address - Fax:501-975-6705
Practice Address - Street 1:4701 FAIRWAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8066
Practice Address - Country:US
Practice Address - Phone:501-975-3616
Practice Address - Fax:501-975-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty