MEDICARE: OBAID A 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	208000000X	Pediatrics Physician	14585	MS

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	:	1972549251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBAID A SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	3650 GROVELAND RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5753
Country	:	US
Telephone Number	:	228-875-0780
Fax Number	:	228-875-1009

Provider Business Practice Location Address
First Line	:	3650 GROVELAND RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5753
Country	:	US
Telephone Number	:	228-875-0780
Fax Number	:	228-875-1009

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/09/2011

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