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Individual

ABDUL-WALI KASIB SIDDIQ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
149 LEE ROAD 974, PHENIX CITY, AL 36870-6891
(716) 335-8502
Mailing address
149 LEE ROAD 974, PHENIX CITY, AL 36870-6891
(716) 335-8502

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
9633859
AL

Other

Enumeration date
05/01/2026
Last updated
05/01/2026
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