Healthcare Provider Details

I. General information

NPI: 1750481305
Provider Name (Legal Business Name): MUHAMMED K. SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 STEPHEN J WHITE MEMORIAL BLVD
TALLADEGA AL
35160-2106
US

IV. Provider business mailing address

119 STEPHEN J WHITE MEMORIAL BLVD
TALLADEGA AL
35160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 256-268-7775
  • Fax: 256-268-7760
Mailing address:
  • Phone: 256-268-7775
  • Fax: 256-268-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19496
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000032739
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier32739
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBC/BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: