Healthcare Provider Details

I. General information

NPI: 1780671537
Provider Name (Legal Business Name): SEEMEEN SIDDIQI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEEMEEN KHAWAJA M.D.

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 W SOUTHERN AVE
APACHE JUNCTION AZ
85120-7305
US

IV. Provider business mailing address

PO BOX 11850
CHANDLER AZ
85248-0015
US

V. Phone/Fax

Practice location:
  • Phone: 602-467-4757
  • Fax: 602-371-4960
Mailing address:
  • Phone: 602-467-4757
  • Fax: 602-371-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27889
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: