Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 17468 | MS |
Y | 207RN0300X | Nephrologist | ME98002 | FL |
NPI | 1003858275 |
---|---|
Provider Name | Dr. Mohammad T Siddiqui |
First Address | Orlando, FL 32806-6257 |
Second Address | Kissimmee, FL 34741-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 28/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2191106 | UNITED HEALTHCARE (01) | FL |
7280103 | AETNA (01) | FL |
94661 | BC/BS (01) | FL |
H11519 | (02) | FL |