Healthcare Provider Details

I. General information

NPI: 1497205843
Provider Name (Legal Business Name): HAMMAD SIDDIQUI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 07/27/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C335
LEXINGTON KY
40504-1791
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE 335
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-2575
  • Fax:
Mailing address:
  • Phone: 859-276-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number55119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: