Basic Information
| Provider Information | |||||||||
| NPI: | 1750481305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | MUHAMMED | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 STONE AVE | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563621725 | ||||||||
| FaxNumber: | 2563622070 | ||||||||
| Practice Location | |||||||||
| Address1: | 722 STONE AVE | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563621725 | ||||||||
| FaxNumber: | 2563622070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 19496 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000032739 | 05 | AL | MEDICAID | 32739 | 01 | AL | BC/BS | OTHER |