Provider Demographics
NPI:1881996197
Name:GASTROINTESTINAL AND LIVER DISORDERS SPECIALISTS PLLC
Entity type:Organization
Organization Name:GASTROINTESTINAL AND LIVER DISORDERS SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIRDOUS
Authorized Official - Middle Name:ANJUM
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-208-9257
Mailing Address - Street 1:27200 LAHSER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2137
Mailing Address - Country:US
Mailing Address - Phone:248-208-9257
Mailing Address - Fax:248-208-9217
Practice Address - Street 1:27200 LAHSER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2137
Practice Address - Country:US
Practice Address - Phone:248-208-9257
Practice Address - Fax:248-208-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060352207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93761Medicare UPIN