Provider Demographics
NPI:1528076718
Name:ABBASI, SIDDIQUE (MD)
Entity type:Individual
Prefix:
First Name:SIDDIQUE
Middle Name:
Last Name:ABBASI
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 1:80 E HILLCREST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4219
Mailing Address - Country:US
Mailing Address - Phone:805-497-3575
Mailing Address - Fax:
Practice Address - Street 1:80 E HILLCREST DR STE 102
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4219
Practice Address - Country:US
Practice Address - Phone:805-497-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249446-1207R00000X
RIMD14689207RC0000X
IL036123863207RC0000X
CAC165619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine