Provider Demographics
NPI:1154730414
Name:MOHAMMED Z SIDDIQUI MEDICAL CONSULTING LLC
Entity type:Organization
Organization Name:MOHAMMED Z SIDDIQUI MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ZAHID
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-330-0171
Mailing Address - Street 1:1313 CAMP JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2202
Mailing Address - Country:US
Mailing Address - Phone:618-332-0900
Mailing Address - Fax:618-332-0943
Practice Address - Street 1:10 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1482
Practice Address - Country:US
Practice Address - Phone:314-330-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097325261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty