MEDICARE: DR. FARJAAD SIDDIQ M.D.

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	208800000X	Urology Physician	15753R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00196869	OTHER	LA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1346231065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARJAAD SIDDIQ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 122525 DEPT 2525
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75312-0001
Country	:	US
Telephone Number	:	337-494-2921
Fax Number	:	337-494-6523

Provider Business Practice Location Address
First Line	:	1715 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-480-7499
Fax Number	:	337-480-7498

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/09/2022

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