Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME118372 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME118372 | FL |
NPI | 1770743890 |
---|---|
Provider Name | Awais Siddiki |
First Address | St Petersburg, FL 33704-2124 |
Second Address | St Petersburg, FL 33704-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014307600 | (05) | FL |