Provider Demographics
NPI:1871517516
Name:SIDDIQUI, ASMA W (MD)
Entity type:Individual
Prefix:
First Name:ASMA
Middle Name:W
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HOGBACK RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9738
Mailing Address - Country:US
Mailing Address - Phone:734-871-1188
Mailing Address - Fax:
Practice Address - Street 1:2004 HOGBACK RD
Practice Address - Street 2:SUITE 14
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9738
Practice Address - Country:US
Practice Address - Phone:734-971-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076602207P00000X, 207Q00000X
FLME 100173207Q00000X
IL036-110391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII15039Medicare UPIN