=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821223280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAKIYA-LUNA SIDDIQUE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2009
-----------------------------------------------------
Last Update Date | 05/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 S CONGRESS AVE
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-548-1467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 BEVINGTON ROAD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | WEST MIDLANDS
-----------------------------------------------------
Zip | B6 6HU
-----------------------------------------------------
Country | GB
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 6148977
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------