Healthcare Provider Details

I. General information

NPI: 1356979074
Provider Name (Legal Business Name): ALI AHMAD SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W DR MARTIN LUTHER KING JR BLVD FL 3
TAMPA FL
33607-6307
US

IV. Provider business mailing address

3003 W DR MARTIN LUTHER KING JR BLVD FL 3
TAMPA FL
33607-6307
US

V. Phone/Fax

Practice location:
  • Phone: 813-554-8983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME183797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: