Individual
DR. FAZEEL MUKHTAR SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7200
Mailing address
2122 HEALTH DR SW STE 160, WYOMING, MI 49519-9402
(616) 252-5790
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036-132058
IL
2084V0102X
Vascular Neurology Physician
036-132058
IL
2084V0102X
Vascular Neurology Physician
Primary
4301116960
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036132058
—
IL
Enumeration date
08/17/2007
Last updated
03/13/2025
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