Provider Demographics
NPI:1740578665
Name:SIDDIQUI, MUHAMMAD FAISAL KHAN (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:FAISAL KHAN
Last Name:SIDDIQUI
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 1:145 EAGLES WALK STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7340
Mailing Address - Country:US
Mailing Address - Phone:770-914-1808
Mailing Address - Fax:770-914-6828
Practice Address - Street 1:145 EAGLES WALK STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7340
Practice Address - Country:US
Practice Address - Phone:770-914-1808
Practice Address - Fax:770-914-6828
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine