Provider Demographics
NPI:1235236530
Name:SIDDIQUI, FAREED
Entity type:Individual
Prefix:
First Name:FAREED
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 HIGHWAY 36 W STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3905
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:612-273-8459
Practice Address - Street 1:2355 HIGHWAY 36 W STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:612-273-8459
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN477752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2366353OtherARAZ
MNB703OtherCHAMPUS
MT0144551Medicaid
MN014954300Medicaid
IA0596098Medicaid
MN132873OtherUCARE
MNHP52812OtherHEALTH PARTNERS
MN16-03684OtherMEDICA CHOICE
WI34666500Medicaid
MN617T4SIOtherBCBS
MN1044143OtherPREFERRED ONE
MN16-02032OtherMEDICA PRIMARY