MEDICARE: DR. JAWED H. 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	207R00000X	Internal Medicine Physician	R6047	MO
2	207R00000X	Internal Medicine Physician	036-056278	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110125678	OTHER	MO	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699705293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAWED H. SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	1415 TOPPING RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1424
Country	:	US
Telephone Number	:	314-984-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	11115 NEW HALLS FERRY RD
Second Line	:	SUITES 301-302
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7613
Country	:	US
Telephone Number	:	314-921-6200
Fax Number	:	314-830-0756

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/20/2008

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Directions to “ DR. JAWED H. SIDDIQUI M.D.” Practice Location

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