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General NPI Number Information
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NPI Number | 1316605025
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Entity Type | Individual
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Provider Name | MOHAMMED SIDDIQ MT(ASCP)
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Gender | Male
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 4700 MILLENIA BLVD STE 175
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City | ORLANDO
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State | FL
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Zip | 32839-6015
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Country | US
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Telephone | 407-442-0343
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 MILLENIA BLVD STE 175
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City | ORLANDO
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State | FL
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Zip | 32839-6015
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Country | US
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Telephone | 407-442-0343
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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 | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | SU4249
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License Number State | FL
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