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Organization
SIRAJ A SIDDIQUI, MD
Active
Organization
SIRAJ A SIDDIQUI, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIRAJ A SIDDIQUI MD (OWNER)
(419) 774-9993
Entity
Organization
Contact information
Practice address
216 W MAIN ST, CRESTLINE, OH 44827-1431
(419) 683-8041
Mailing address
1613 HIDDEN OAK TRL, MANSFIELD, OH 44906-3558
(419) 774-9993
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35065056S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000140397
ANTHEM
OH
05
—
0954347
—
OH
Enumeration date
11/01/2007
Last updated
11/01/2007
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