| Tahir Siddiq | |
|
441 Chaseway Dr Pike Road AL 36064-3312 | |
| (334) 396-0201 | |
| Not Available |
| Full Name | Tahir Siddiq |
|---|---|
| Speciality | Clinic/Center |
| Location | 441 Chaseway Dr, Pike Road, Alabama |
| Authorized Official Name and Position | Tahir Siddiq (OWNER) |
| Authorized Official Contact | 4695304932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tahir Siddiq 441 Chaseway Dr Pike Road AL 36064-3312 Ph: (469) 530-4932 | Tahir Siddiq 441 Chaseway Dr Pike Road AL 36064-3312 Ph: (334) 396-0201 |
| NPI Number | 1114591393 |
|---|---|
| Provider Enumeration Date | 05/13/2021 |
| Last Update Date | 07/13/2022 |
| Medicare PECOS PAC ID | 6406246610 |
|---|---|
| Medicare Enrollment ID | O20211202001131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114591393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tahir Siddiq |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174631758 PECOS PAC ID: 6800860396 Enrollment ID: I20111017000321 |
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