Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 048136 | MI |
NPI | 1003984535 |
---|---|
Provider Name | Yousuf A. Siddiqui |
First Address | Sterling Heights, MI 48313 |
Second Address | Sterling Heights, MI 48313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A76085 | (02) | |
YS048136 | CHAMPUS-CHAMPUS (01) | |
YS048136 | COMMERCIAL-COMMERCIAL NUMBER (01) |