Provider Demographics
NPI:1245251321
Name:SIDDIQUI, UMER HAFEEZ (MD)
Entity type:Individual
Prefix:
First Name:UMER
Middle Name:HAFEEZ
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 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-231-6245
Mailing Address - Fax:636-231-6244
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-231-6245
Practice Address - Fax:636-231-6244
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007038366207RP1001X
IL036.116212207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116212Medicaid
MO1245251321Medicaid
MOMA1237010Medicare PIN
IL036116212Medicaid
I59133Medicare UPIN