MEDICARE: DR. FARHAN SIDDIQUI M.D.

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	207RP1001X	Pulmonary Disease Physician	33422	SC
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	33422	SC
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2012-01820	NC
4	207RP1001X	Pulmonary Disease Physician	2012-01820	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447461579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARHAN SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	151 HAROLD FLEMING CT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-573-6320
Fax Number	:	864-208-0352

Provider Business Practice Location Address
First Line	:	151 HAROLD FLEMING CT
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4225
Country	:	US
Telephone Number	:	864-573-6320
Fax Number	:	864-208-0352

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	04/25/2016

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