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General NPI Number Information
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NPI Number | 1073882908
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Entity Type | Individual
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Provider Name | MUNEEBUL SIDDIQUI D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 7031 SW 62ND AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4701
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Country | US
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Telephone | 305-284-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 W 49TH PL
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City | HIALEAH
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State | FL
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Zip | 33012-3197
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS15839
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License Number State | FL
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