Provider Demographics
NPI:1841234770
Name:SIDDIQUI, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
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 1:4519 GEORGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7329
Mailing Address - Country:US
Mailing Address - Phone:813-496-1075
Mailing Address - Fax:813-249-7762
Practice Address - Street 1:4519 GEORGE RD
Practice Address - Street 2:STE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7329
Practice Address - Country:US
Practice Address - Phone:813-496-1075
Practice Address - Fax:813-249-7762
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94589207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology