Healthcare Provider Details

I. General information

NPI: 1306541974
Provider Name (Legal Business Name): NIAZ SIDDIQUI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6161 S YALE AVE
TULSA OK
74136-1902
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-1900
  • Fax: 918-494-6303
Mailing address:
  • Phone: 918-502-1900
  • Fax: 918-494-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9913
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: