Provider Demographics
NPI:1912984980
Name:MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES, PC
Other - Org Name:ATHAR SIDDIQUI, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-483-7136
Mailing Address - Street 1:428 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5662
Mailing Address - Country:US
Mailing Address - Phone:734-483-7136
Mailing Address - Fax:734-483-3422
Practice Address - Street 1:428 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5662
Practice Address - Country:US
Practice Address - Phone:734-483-7136
Practice Address - Fax:734-483-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M09660Medicare ID - Type Unspecified