Provider Demographics
NPI:1538499470
Name:SIDDIQI, SHAFI ULLAH (MD)
Entity Type:Individual
Prefix:
First Name:SHAFI
Middle Name:ULLAH
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:31569 CANYON ESTATES DR
Mailing Address - Street 2:STE 201
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0475
Mailing Address - Country:US
Mailing Address - Phone:951-226-0866
Mailing Address - Fax:951-226-0868
Practice Address - Street 1:31569 CANYON ESTATES DR
Practice Address - Street 2:STE 201
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0475
Practice Address - Country:US
Practice Address - Phone:951-226-0866
Practice Address - Fax:951-226-0868
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA102176208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice