Provider Demographics
NPI:1528580834
Name:SIDDIQUI, ANAS (MD)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 TERRITORY LN
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-6503
Mailing Address - Country:US
Mailing Address - Phone:405-252-3550
Mailing Address - Fax:405-252-3555
Practice Address - Street 1:3345 TERRITORY LN
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-6503
Practice Address - Country:US
Practice Address - Phone:405-252-3550
Practice Address - Fax:405-252-3555
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine