Provider Demographics
NPI:1710734835
Name:SIDDIQUI, MUHAMMAD MUSTAFA ARIF (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD MUSTAFA
Middle Name:ARIF
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 1:6071 OUTER DR. W
Mailing Address - Street 2:DETROIT MI 48235
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-966-7434
Mailing Address - Fax:313-966-1738
Practice Address - Street 1:6071 OUTER DR. W DETROIT MI 48235
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-7434
Practice Address - Fax:313-966-1738
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program