MEDICARE: SIRAJ A 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	207R00000X	Internal Medicine Physician	35065056	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000140397	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518999333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRAJ A SIDDIQUI MD

Provider Business Mailing Address
First Line	:	PO BOX 3804
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-3804
Country	:	US
Telephone Number	:	419-884-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2666 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44904-1428
Country	:	US
Telephone Number	:	419-884-7232
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/15/2020

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Directions to “ SIRAJ A SIDDIQUI MD” Practice Location

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