MEDICARE: DR. FAHAD SHOAIB SIDDIQUI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	OS20922	FL
2	207N00000X	Dermatology Physician	02008913A	IN

General Provider Information

NPI Number	:	1215687363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAHAD SHOAIB SIDDIQUI DO

Provider Business Mailing Address
First Line	:	545 BARNHILL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5112
Country	:	US
Telephone Number	:	317-278-6833
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 UNIVERSITY BLVD STE 3240
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5149
Country	:	US
Telephone Number	:	317-944-7744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2022
Last Update Date	:	05/25/2026

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