Provider Demographics
NPI:1750874905
Name:SIDDIQUI, ZUBAIR HASAN (MD)
Entity type:Individual
Prefix:MR
First Name:ZUBAIR
Middle Name:HASAN
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:FLAT 601-A, HNO:-8-1-402/35-41; HYDERABAD HOMES, GULSHA
Mailing Address - Street 2:
Mailing Address - City:HYDERABAD
Mailing Address - State:TELANGANA
Mailing Address - Zip Code:5000008
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 315
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-385-2592
Practice Address - Fax:414-385-2591
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-02-16
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-02-06
Provider Licenses
StateLicense IDTaxonomies
KY55388207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program