Provider Demographics
NPI:1538107651
Name:SIDDIQUI, FIRDOUS ANJUM (MD)
Entity Type:Individual
Prefix:
First Name:FIRDOUS
Middle Name:ANJUM
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27209 LAHSER RD STE 226
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8403
Mailing Address - Country:US
Mailing Address - Phone:248-945-1220
Mailing Address - Fax:248-945-1222
Practice Address - Street 1:27209 LAHSER RD STE 226
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8403
Practice Address - Country:US
Practice Address - Phone:248-945-1220
Practice Address - Fax:248-945-1222
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060352207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG93761Medicare UPIN