Provider Demographics
NPI:1922024751
Name:SIDDIQUI, MOHAMMAD RASHID (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:RASHID
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:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-629-8416
Mailing Address - Fax:517-629-6640
Practice Address - Street 1:27931 C DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8402
Practice Address - Country:US
Practice Address - Phone:517-629-8416
Practice Address - Fax:517-629-6640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS033848207QG0300X
MI4301033848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D90122Medicare UPIN