Provider Demographics
NPI:1881634368
Name:SIDDIQUI, KHURSHEED A (MD)
Entity Type:Individual
Prefix:MR
First Name:KHURSHEED
Middle Name:A
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 1:300 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1408
Mailing Address - Country:US
Mailing Address - Phone:859-236-0606
Mailing Address - Fax:859-236-0066
Practice Address - Street 1:300 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1408
Practice Address - Country:US
Practice Address - Phone:859-236-0606
Practice Address - Fax:859-236-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28741207LP2900X, 207L00000X, 2084A0401X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64287410Medicaid
KY64287410Medicaid
KYP00282418Medicare PIN
KY0928001Medicare PIN
KYP00211449Medicare PIN