Provider Demographics
NPI:1811037724
Name:T. SIDDIQI, M.D., P.C.
Entity Type:Organization
Organization Name:T. SIDDIQI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-2176
Mailing Address - Street 1:755 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1442
Mailing Address - Country:US
Mailing Address - Phone:517-265-2175
Mailing Address - Fax:517-264-5926
Practice Address - Street 1:755 HIGH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1442
Practice Address - Country:US
Practice Address - Phone:517-265-2175
Practice Address - Fax:517-264-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS069384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4594755Medicaid
MI4594755Medicaid
MI0N90100Medicare PIN