MEDICARE: MS. ISHRAT SIDDIQUE 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	208000000X	Pediatrics Physician	49096	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	:	1639119381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ISHRAT SIDDIQUE MD

Provider Business Mailing Address
First Line	:	2561 N 29TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-3116
Country	:	US
Telephone Number	:	414-264-5338
Fax Number	:	414-264-5625

Provider Business Practice Location Address
First Line	:	2561 N 29TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-3116
Country	:	US
Telephone Number	:	414-264-5338
Fax Number	:	414-264-5625

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	12/23/2011

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