Healthcare Provider Details

I. General information

NPI: 1154260826
Provider Name (Legal Business Name): OMER SIDDIQUI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 REPUBLICAN ST BOX 358047
SEATTLE WA
98109-4725
US

IV. Provider business mailing address

850 REPUBLICAN ST BOX 358047
SEATTLE WA
98109-4725
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMDRE.ML.70114461
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: