Healthcare Provider Details

I. General information

NPI: 1760525471
Provider Name (Legal Business Name): MEHAR M SIDDIQUI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 PARTRIDGE DR
WINTER HAVEN FL
33884-3035
US

IV. Provider business mailing address

2544 PARTRIDGE DR
WINTER HAVEN FL
33884-3035
US

V. Phone/Fax

Practice location:
  • Phone: 863-318-9193
  • Fax: 863-324-0933
Mailing address:
  • Phone: 863-318-9193
  • Fax: 863-324-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME31293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: