Provider Demographics
NPI:1932546140
Name:SIDDIQUI, SOHAIL MOHIUDDIN (DPM)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:MOHIUDDIN
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-339-7759
Mailing Address - Fax:
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-339-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006499213ES0103X
FLPO3833213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery