Provider Demographics
NPI:1689643801
Name:SIDDIQI, MUNAWAR (MD)
Entity Type:Individual
Prefix:
First Name:MUNAWAR
Middle Name:
Last Name:SIDDIQI
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 1:106 FORTRESS PROPERTIES ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3125
Mailing Address - Country:US
Mailing Address - Phone:859-224-9989
Mailing Address - Fax:606-877-4560
Practice Address - Street 1:106 FORTRESS PROPERTIES ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3125
Practice Address - Country:US
Practice Address - Phone:859-224-9989
Practice Address - Fax:606-877-4560
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38485207LP2900X
OH35077460207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2346170Medicaid
OH2346170Medicaid
OH2346170Medicaid