Provider Demographics
NPI:1902933211
Name:SIDDIQUI, SAMUEL FARHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FARHAN
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16244 S MILITARY TRL STE 150
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6505
Mailing Address - Country:US
Mailing Address - Phone:561-638-8872
Mailing Address - Fax:561-638-8874
Practice Address - Street 1:16244 S MILITARY TRL STE 150
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6505
Practice Address - Country:US
Practice Address - Phone:561-638-8872
Practice Address - Fax:561-638-8874
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME724762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG59768Medicare UPIN
FLE4428XMedicare ID - Type Unspecified