Provider Demographics
NPI:1457396921
Name:SIDDIQUI, ZIA AHMED (MD)
Entity Type:Individual
Prefix:
First Name:ZIA
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 1:1427 RIVERBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-6501
Mailing Address - Country:US
Mailing Address - Phone:651-304-2130
Mailing Address - Fax:
Practice Address - Street 1:1427 RIVERBLUFF DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-6501
Practice Address - Country:US
Practice Address - Phone:651-304-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42293208M00000X
AK6280207Q00000X
OH35-068921-S207Q00000X
WI45115-020207Q00000X
MN37529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F92304Medicare UPIN
MN080014119Medicare ID - Type Unspecified