Provider Demographics
NPI:1962598086
Name:SIDDIQUI, MOHAMMED ABDUL RAOOF (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ABDUL RAOOF
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 1:13 W US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2266
Mailing Address - Country:US
Mailing Address - Phone:219-865-0918
Mailing Address - Fax:
Practice Address - Street 1:13 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2266
Practice Address - Country:US
Practice Address - Phone:219-865-0918
Practice Address - Fax:219-864-8332
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100356480DMedicaid
F64044Medicare UPIN
IN100356480DMedicaid