Healthcare Provider Details

I. General information

NPI: 1538574660
Provider Name (Legal Business Name): AMAR SIDDIQUE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/20/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N MEDICAL CENTER DR E STE 205
CLOVIS CA
93611-6886
US

IV. Provider business mailing address

726 N MEDICAL CENTER DR E STE 205
CLOVIS CA
93611-6886
US

V. Phone/Fax

Practice location:
  • Phone: 559-908-4852
  • Fax: 559-354-5214
Mailing address:
  • Phone: 559-908-4852
  • Fax: 559-354-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA93835
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93835
License Number StateCA

VIII. Authorized Official

Name: DR. AMAR SIDDIQUE
Title or Position: PRESIDENT
Credential: M.D
Phone: 559-908-4852