Healthcare Provider Details

I. General information

NPI: 1417267030
Provider Name (Legal Business Name): RESHMA A SIDDIQI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 06/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICENTRES CLINIC, JUMEIRAH PARK PAVILLION JPV-RTL 12
DUBAI UAE
42224
AE

IV. Provider business mailing address

16344 HEATHROW DR
TAMPA FL
33647-2641
US

V. Phone/Fax

Practice location:
  • Phone: 971551474784
  • Fax:
Mailing address:
  • Phone: 352-552-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN7750
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08349300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128160
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDHA-P-0053246
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: