Healthcare Provider Details

I. General information

NPI: 1982848719
Provider Name (Legal Business Name): BUSHRA SIDDIQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND AVE SUITE 220
OKLAHOMA CITY OK
73112-2121
US

IV. Provider business mailing address

820 W DANFORTH RD SUITE 302
EDMOND OK
73103-5006
US

V. Phone/Fax

Practice location:
  • Phone: 405-694-4966
  • Fax: 405-604-4331
Mailing address:
  • Phone: 405-217-0203
  • Fax: 405-604-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number29723
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: