Provider Demographics
NPI:1063548097
Name:SIDDIQUI, IRFAN F (DO)
Entity type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:F
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0188
Mailing Address - Country:US
Mailing Address - Phone:863-424-3278
Mailing Address - Fax:863-420-9701
Practice Address - Street 1:405 LIONEL WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7811
Practice Address - Country:US
Practice Address - Phone:863-424-3278
Practice Address - Fax:863-420-9701
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015831207R00000X
UT7294934-1204207RC0000X
FLOS10711207RI0011X
FLOS 10711207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC828ZMedicare PIN