Provider Demographics
NPI:1801117353
Name:SIDDIQUI, LAILA F (MD)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:F
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVENUE #300
Mailing Address - Street 2:COMMUNITY HEALTH CARE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:1708 EAST 44TH STREET
Practice Address - Street 2:COMMUNITY HEALTH CARE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404
Practice Address - Country:US
Practice Address - Phone:253-471-4553
Practice Address - Fax:253-474-5395
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60334135207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program