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General NPI Number Information
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NPI Number | 1912382870
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Entity Type | Individual
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Provider Name | SIDDIQUE CHAUDHARY
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Gender | Male
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 1825 LOGAN AVE
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City | WATERLOO
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State | IA
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Zip | 50703
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Country | US
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Telephone | 319-235-3941
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 LOGAN AVE
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City | WATERLOO
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State | IA
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Zip | 50703
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Country | US
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Telephone | 319-235-3941
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 431108019
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD-47998
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD-47998
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License Number State | IA
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