Provider Demographics
NPI:1245295328
Name:SIDDIQI, SHAMEEM M (MD)
Entity type:Individual
Prefix:MRS
First Name:SHAMEEM
Middle Name:M
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAHEEH
Other - Middle Name:FIRDOUS
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 EAST COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-938-0006
Mailing Address - Fax:954-938-5201
Practice Address - Street 1:100 EAST COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-938-0006
Practice Address - Fax:954-938-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039910208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066453700Medicaid
FL066453700Medicaid