Provider Demographics
NPI:1386800696
Name:SIDDIQUI, SHARIFUZZAMA (MD)
Entity type:Individual
Prefix:
First Name:SHARIFUZZAMA
Middle Name:
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 1:36123 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-793-6140
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:50 LAKEFRONT BLVD STE 130
Practice Address - Street 2:IPC HOSPITALIST SERVICES OF NEW YORK, PC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4327
Practice Address - Country:US
Practice Address - Phone:716-849-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1915372084P0800X
NY260211-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry