Healthcare Provider Details

I. General information

NPI: 1386170850
Provider Name (Legal Business Name): FARHAN SIDDIQI, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 NIGHTWALKER RD
WEEKI WACHEE FL
34613-6349
US

IV. Provider business mailing address

7005 NIGHTWALKER RD
WEEKI WACHEE FL
34613-6349
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-2524
  • Fax:
Mailing address:
  • Phone: 352-556-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARHAN SIDDIQI
Title or Position: PRESIDENT
Credential: MD
Phone: 352-556-2524