Provider Demographics
NPI:1649387846
Name:SIDDIQUE, AWAIS H (MD)
Entity Type:Individual
Prefix:DR
First Name:AWAIS
Middle Name:H
Last Name:SIDDIQUE
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 1:2500 W LAYTON AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:262-577-0250
Mailing Address - Fax:262-577-0251
Practice Address - Street 1:2500 W LAYTON AVE STE 40
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:262-577-0250
Practice Address - Fax:262-577-0251
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI458102085R0202X, 2085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11176041OtherCAQH
WI34391800Medicaid
WI025760040Medicare PIN
WI028671480Medicare PIN
WI34391800Medicaid
WI020865185Medicare PIN