Provider Demographics
NPI:1659577278
Name:ASIF SIDDIQUI, OMER (MD)
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:ASIF SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMER
Other - Middle Name:MUHAMMAD
Other - Last Name:ASIF SIDDIQUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1407 UNION AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3641
Mailing Address - Country:US
Mailing Address - Phone:901-866-8622
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE STE 445
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7536
Practice Address - Country:US
Practice Address - Phone:901-866-8810
Practice Address - Fax:901-302-2450
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46512207R00000X, 207RN0300X
MS23721207R00000X
ARE6551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187456001Medicaid
TN1524078Medicaid
MS03001574Medicaid