Provider Demographics
NPI:1558616482
Name:MUQEET SIDDIQUI, MD, LLC
Entity Type:Organization
Organization Name:MUQEET SIDDIQUI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUQEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-295-5625
Mailing Address - Street 1:724 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7509
Mailing Address - Country:US
Mailing Address - Phone:407-295-5625
Mailing Address - Fax:407-294-2281
Practice Address - Street 1:724 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7509
Practice Address - Country:US
Practice Address - Phone:407-295-5625
Practice Address - Fax:407-294-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty