Provider Demographics
NPI:1760910327
Name:SIDDIQUI, OMAMA (MD)
Entity Type:Individual
Prefix:
First Name:OMAMA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:46591 ROMEO PLANK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5705
Mailing Address - Country:US
Mailing Address - Phone:586-226-6080
Mailing Address - Fax:586-226-6421
Practice Address - Street 1:46591 ROMEO PLANK RD STE 107
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5705
Practice Address - Country:US
Practice Address - Phone:586-226-6080
Practice Address - Fax:586-226-6421
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2023-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301501762207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine