Provider Demographics
NPI:1700028347
Name:ALI, FATIMA SIDDIQUA (MD)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:SIDDIQUA
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FATIMA
Other - Middle Name:
Other - Last Name:SIDDIQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5500 E KELLOGG
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS33044207R00000X
KS04-33044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200606990AMedicaid
KS003719044Medicare PIN