Provider Demographics
NPI:1780671537
Name:SIDDIQI, SEEMEEN (MD)
Entity Type:Individual
Prefix:
First Name:SEEMEEN
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEEMEEN
Other - Middle Name:
Other - Last Name:KHAWAJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11850
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0015
Mailing Address - Country:US
Mailing Address - Phone:602-467-4757
Mailing Address - Fax:602-371-4960
Practice Address - Street 1:2050 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7305
Practice Address - Country:US
Practice Address - Phone:602-467-4757
Practice Address - Fax:602-371-4960
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480103Medicaid
AZZWDCFLOtherGROUP PTAN
AZZWDCFLOtherGROUP PTAN
H02975Medicare UPIN