Provider Demographics
NPI:1629001680
Name:SIDDIQUI, SHAZIA MERAJ (MD)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:MERAJ
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:PO BOX 5748
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5748
Mailing Address - Country:US
Mailing Address - Phone:765-714-4344
Mailing Address - Fax:765-838-3200
Practice Address - Street 1:770 PARK EAST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-714-4344
Practice Address - Fax:765-838-3200
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059790A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201148960Medicaid
AR5N6717143Medicare PIN