Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 68299-20 | WI |
NPI | 1003278268 |
---|---|
Provider Name | Abdulrehman Siddiqui |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Greenfield, WI 53220-4420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100075227 | (05) | WI |