Provider Demographics
NPI:1821393562
Name:SIDDIQUI, MOHSIN (DO)
Entity Type:Individual
Prefix:
First Name:MOHSIN
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-438-3450
Mailing Address - Fax:954-416-0849
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 403
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-438-3450
Practice Address - Fax:954-416-0849
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO1999207R00000X
TXS8386207R00000X
FLOS11150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine