Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301052229 | MI |
NPI | 1003963810 |
---|---|
Provider Name | Raffat A. Siddiqi |
First Address | Detroit, MI 48235 |
Second Address | Detroit, MI 48235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 28/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192570010 | (05) | MI |
700H262280 | BLUE CROSS-BLUE CROSS (01) | |
E50123 | (02) | |
RS052229 | CHAMPUS-CHAMPUS (01) | |
RS052229 | COMMERCIAL-COMMERCIAL NUMBER (01) |