Healthcare Provider Details

I. General information

NPI: 1922024751
Provider Name (Legal Business Name): MOHAMMAD RASHID SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27931 C DR N
ALBION MI
49224-8402
US

IV. Provider business mailing address

PO BOX 67000 DEPARTMENT 272801
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-629-8416
  • Fax: 517-629-6640
Mailing address:
  • Phone: 517-629-8416
  • Fax: 517-629-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301033848
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMS033848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: