Healthcare Provider Details

I. General information

NPI: 1326570060
Provider Name (Legal Business Name): DANIYAL IKHLAS SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY EMERGENCY MEDICINE
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-2623
  • Fax:
Mailing address:
  • Phone: 352-265-5911
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME155095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: