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General NPI Number Information
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NPI Number | 1154730414
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Entity Type | Organization
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Legal Business Name | MOHAMMED Z SIDDIQUI MEDICAL CONSULTING LLC
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 10 OVERBROOK DR
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1482
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Country | US
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Telephone | 314-330-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 CAMP JACKSON RD
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City | CAHOKIA
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State | IL
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Zip | 62206-2202
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Country | US
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Telephone | 618-332-0900
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Fax | 618-332-0943
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MOHAMMED ZAHID SIDDIQUI
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Credential | M.D
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Telephone | 314-330-0171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036-097325
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License Number State | IL
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