Provider Demographics
NPI:1740426774
Name:SIDDIQUE, MUHAMMAD KAMRAN (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:KAMRAN
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:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:2977 FOUR H PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2237
Practice Address - Country:US
Practice Address - Phone:410-758-4030
Practice Address - Fax:107-584-7334
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40042207RH0003X
MDD0076690207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100062280Medicaid
KY000000598659OtherANTHEM BCBS
KY000000598659OtherANTHEM BCBS
KYP00682367Medicare PIN
KY00280097Medicare PIN