MEDICARE: MR. MOHAMMED IDREES HASAN SIDDIQUI D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609706977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOHAMMED IDREES HASAN SIDDIQUI D.O.

Provider Business Mailing Address
First Line	:	2990 MACK ROAD
Second Line	:	1ST FLOOR GME ADMIN
City	:	FAIRFIELD
State	:	OH
Zip	:	45014
Country	:	US
Telephone Number	:	786-913-9392
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 MACK ROAD
Second Line	:	1RST FLOOR GME ADMIN
City	:	FAIRFIELD
State	:	OH
Zip	:	45014
Country	:	US
Telephone Number	:	513-870-7800
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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