MEDICARE: OAKS INTERNAL MEDICINE, A PROFESSIONAL MEDICAL CORPORATION

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	207R00000X	Internal Medicine Physician	A65725	CA

General Provider Information

NPI Number	:	1306149562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKS INTERNAL MEDICINE, A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3295 OLD CONEJO RD
Second Line	:	SUITE 201
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2152
Country	:	US
Telephone Number	:	805-375-6000
Fax Number	:	805-375-0011

Provider Business Practice Location Address
First Line	:	3295 OLD CONEJO ROAD
Second Line	:	SUITE 201
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-2152
Country	:	US
Telephone Number	:	805-375-6000
Fax Number	:	805-375-0011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ASRA S. I. SIDDIQUI
Credential	:	M.D.
Telephone Number	:	805-375-6000

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	11/02/2011

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