MEDICARE: SIDRA SIDDIQUI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IN
2	207Q00000X	Family Medicine Physician	V9978	TX

General Provider Information

NPI Number	:	1285376921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDRA SIDDIQUI MD

Provider Business Mailing Address
First Line	:	1415 BETHPAGE WAY
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3034
Country	:	US
Telephone Number	:	561-317-3169
Fax Number	:

Provider Business Practice Location Address
First Line	:	8480 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2004
Country	:	US
Telephone Number	:	281-550-9005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	08/08/2025

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Directions to “ SIDRA SIDDIQUI MD” Practice Location

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