Provider Demographics
NPI:1154726271
Name:ANESTHESIA PRACTICE MANAGEMENT LLC
Entity type:Organization
Organization Name:ANESTHESIA PRACTICE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSSARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-558-8504
Mailing Address - Street 1:4250 ALAFAYA TRL # 212149
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9412
Mailing Address - Country:US
Mailing Address - Phone:407-558-8504
Mailing Address - Fax:
Practice Address - Street 1:598 STERTHAUS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5128
Practice Address - Country:US
Practice Address - Phone:407-558-8504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45934207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty