Basic Information
| Provider Information | |||||||||
| NPI: | 1841234770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4519 GEORGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336347329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
| FaxNumber: | 8132497762 | ||||||||
| Practice Location | |||||||||
| Address1: | 4519 GEORGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336347329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
| FaxNumber: | 8132497762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME94589 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.