MEDICARE: DR. TALHA ALI SIDDIQUI M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C1-0025448	DE
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME154114	FL
3	2084P0800X	Psychiatry Physician	314306	NY
4	2084P0804X	Child & Adolescent Psychiatry Physician	C1-0025448	DE
5	2084P0800X	Psychiatry Physician	MD476686	PA
6	2084P0804X	Child & Adolescent Psychiatry Physician	314306	NY
7	2084P0804X	Child & Adolescent Psychiatry Physician	65632	AZ
8	2084P0800X	Psychiatry Physician	ME154114	FL
9	2084P0804X	Child & Adolescent Psychiatry Physician	MD476686	PA
10	2084P0800X	Psychiatry Physician	65632	AZ

NPI Number	:	1578790531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALHA ALI SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	3240 CHAMPION RING RD APT 1414
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-6180
Country	:	US
Telephone Number	:	516-209-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	13121 ATLANTIC BLVD STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0102
Country	:	US
Telephone Number	:	516-209-7311
Fax Number	:

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

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	01/05/2026

13121 ATLANTIC BLVD STE 100
JACKSONVILLE, FL
32225-0102

Practice Phone: 904-221-2232
Practice Fax: 904-244-3455