Healthcare Provider Details

I. General information

NPI: 1508271586
Provider Name (Legal Business Name): SAMEER SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD, 128 (W)
CLEVELAND OH
44106
US

IV. Provider business mailing address

10701 EAST BLVD, 128 (W)
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 216-791-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number274909
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: