Individual
DR. BILAL A SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-7000
Mailing address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-7000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
S0090
TX
390200000X
Student in an Organized Health Care Education/Training Program
263857
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400480601
—
TX
01
—
400480602
MEDICAID-CSHCN
TX
01
—
8LK672
BCBS
TX
Enumeration date
06/05/2015
Last updated
09/19/2019
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