Organization
LAKE HAVASU PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESSA J SIDIQI M.D. (OWNER/MEMBER/MANAGER)
(928) 453-0777
Entity
Organization
Contact information
Practice address
1830 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5885
(928) 453-0777
(928) 453-0778
Mailing address
1830 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5885
(928) 453-0777
(928) 453-0778
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
48667
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P-1982371-1
PLLC REGISTRATION NUMBER
AZ
Enumeration date
02/11/2015
Last updated
02/11/2015
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