Individual
DR. SHOAIB SIDDIQUI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 PARK PLACE BLVD. BLDG. D, SUITE 3, KISSIMMEE, FL 34741-4213
(407) 944-4900
(407) 483-0688
Mailing address
102 PARK PLACE BLVD. BLDG. D, SUITE 3, KISSIMMEE, FL 34741-2358
(407) 944-4900
(407) 483-0688
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME75997
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166307
WELLCARE
FL
05
—
258319400
—
FL
01
—
49824
BCBS
FL
Enumeration date
06/07/2007
Last updated
11/13/2017
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