Healthcare Provider Details

I. General information

NPI: 1407853005
Provider Name (Legal Business Name): MUHAMMAD M SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13505 US HIGHWAY 1
SEBASTIAN FL
32958-3759
US

IV. Provider business mailing address

1555 INDIAN RIVER BLVD STE B210
VERO BEACH FL
32960-7113
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-8224
  • Fax: 772-213-3157
Mailing address:
  • Phone: 772-257-8224
  • Fax: 772-252-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME23240
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME00232410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: