Healthcare Provider Details

I. General information

NPI: 1114973922
Provider Name (Legal Business Name): MERAJ SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HARRISON ST STE T
BATESVILLE AR
72501-7315
US

IV. Provider business mailing address

125 DENNISON HTS
BATESVILLE AR
72501-8936
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-6155
  • Fax: 870-262-6512
Mailing address:
  • Phone: 870-834-4499
  • Fax: 870-262-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberR5039
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE4737
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR5039
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE4737
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: