Organization
KOKOMO AMBULATORY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAZIA M SIDDIQUI MD (OWNER)
(765) 450-6735
Entity
Organization
Contact information
Practice address
107 S WASHINGTON ST STE A, KOKOMO, IN 46901-4601
(765) 450-6735
(765) 838-3200
Mailing address
PO BOX 5748, LAFAYETTE, IN 47903-5748
(765) 714-4344
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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