Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2021021665 | MO |
NPI | 1073184933 |
---|---|
Provider Name | Dr. Esra Siddeek |
First Address | Kirksville, MO 63501-1443 |
Second Address | Kirksville, MO 63501-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 19/11/2021 |