MEDICARE: SIRAJ U SIDDIQUI 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	207QA0505X	Adult Medicine Physician	123278	NY

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	:	1598767840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRAJ U SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	238 N MAIN ST
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-1046
Country	:	US
Telephone Number	:	585-593-0400
Fax Number	:	585-593-0700

Provider Business Practice Location Address
First Line	:	238 N MAIN ST
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-1046
Country	:	US
Telephone Number	:	585-593-0400
Fax Number	:	585-593-0700

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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