Provider Demographics
NPI:1932233566
Name:SIDDIQI, IMRAN E (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:E
Last Name:SIDDIQI
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-716-7911
Mailing Address - Fax:843-716-7918
Practice Address - Street 1:3710 MISHOE STREET
Practice Address - Street 2:MED SHARE BLDG.
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2822
Practice Address - Country:US
Practice Address - Phone:843-716-7911
Practice Address - Fax:843-716-7918
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33339207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34705Medicare UPIN