Provider Demographics
NPI:1891965489
Name:SIDDIQUI, SABEEH AHMED (MD)
Entity Type:Individual
Prefix:
First Name:SABEEH
Middle Name:AHMED
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 1:5106 VILLAGE PLACE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3378
Mailing Address - Country:US
Mailing Address - Phone:248-497-1548
Mailing Address - Fax:
Practice Address - Street 1:2999 INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7903
Practice Address - Country:US
Practice Address - Phone:724-983-1800
Practice Address - Fax:724-983-8252
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085923207RA0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271968Medicaid
MISS085923OtherLICENSE
MI205485614OtherTAX ID
MI0P41360016Medicare PIN