MEDICARE: DANISH S SIDDIQUI MD

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	207V00000X	Obstetrics & Gynecology Physician	45479	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215987128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANISH S SIDDIQUI MD

Provider Business Mailing Address
First Line	:	3270 FORDHAM CT
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-2775
Country	:	US
Telephone Number	:	262-373-0687
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W BLUEMOUND RD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3367
Country	:	US
Telephone Number	:	414-302-3800
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/24/2011

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