Individual
GHULAM JEELANI SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2115 S FREMONT AVE, SUITE 3300, SPRINGFIELD, MO 65804-2239
(417) 820-5200
(417) 820-5220
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
2013004553
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023260874
—
MO
Enumeration date
10/10/2008
Last updated
02/06/2014
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