Provider Demographics
NPI:1831369842
Name:SHAHID K SIDDIQUI MD INC
Entity type:Organization
Organization Name:SHAHID K SIDDIQUI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HABEEB
Authorized Official - Middle Name:M
Authorized Official - Last Name:AWAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-844-9670
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-926-8100
Mailing Address - Fax:408-926-8103
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE 320
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-926-8100
Practice Address - Fax:408-926-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84465302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization