Healthcare Provider Details

I. General information

NPI: 1780369603
Provider Name (Legal Business Name): MUHAMMAD ALI SIDDIQUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13067 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0926
US

IV. Provider business mailing address

VBMC-UTRGV IM 2101 PEASE STREET SUITE 200
HARLINGTON TX
78550
US

V. Phone/Fax

Practice location:
  • Phone: 813-779-6303
  • Fax: 786-868-0012
Mailing address:
  • Phone: 956-296-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME178278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: