Individual
SHAD SIDDIQI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
22250 PROVIDENCE DR STE 401, SOUTHFIELD, MI 48075-6212
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
5101024603
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
5101024603
MI
Other
Enumeration date
05/23/2014
Last updated
08/01/2019
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