Healthcare Provider Details

I. General information

NPI: 1003072760
Provider Name (Legal Business Name): MAHREEN A SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAHREEN M ALAVI MBBS

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CONCORD TERRACE, 5TH FLOOR
SUNRISE FL
33323-3009
US

IV. Provider business mailing address

1500 CONCORD TERRACE, 5TH FLOOR
SUNRISE FL
33323-3009
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-0175
  • Fax: 954-851-1838
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-851-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME110342
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME110342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: