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General NPI Number Information
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NPI Number | 1780812594
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Entity Type | Individual
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Provider Name | SIDIQ NAZAR ALDABBAGH M.D
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Gender | Male
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-243-4960
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Fax | 305-585-7651
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Provider Business Mailing Address
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Address Line | 8600 SW 92ND ST STE 103
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City | MIAMI
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State | FL
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Zip | 33156-7377
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Country | US
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Telephone | 786-360-4334
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Fax | 786-360-4578
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301093891
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 116310
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME116310
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License Number State | FL
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