Provider Demographics
NPI:1356597421
Name:SIDDIQUI, ATIYA A (MD)
Entity type:Individual
Prefix:DR
First Name:ATIYA
Middle Name:A
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6261
Mailing Address - Fax:608-743-3214
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6261
Practice Address - Fax:608-743-3214
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263886207R00000X
WI60775-20208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WISIDDIATIOtherMERCYCARE INSURANCE
WI1356597421Medicaid
WI1356597421OtherBCBSWI
IL$$$$$$$$$ 1Medicaid
WI541760988Medicare PIN