Provider Demographics
NPI:1558563890
Name:ELSIDDIG, HASSAN DAWOUD (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:DAWOUD
Last Name:ELSIDDIG
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 1:1083 RUE LA VILLE WALK
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6272
Mailing Address - Country:US
Mailing Address - Phone:314-542-2501
Mailing Address - Fax:314-771-8575
Practice Address - Street 1:3660 VISTA AVE # 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2540
Practice Address - Country:US
Practice Address - Phone:314-977-8462
Practice Address - Fax:314-771-8575
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2005027548207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine