1720074297 NPI number — ASMA A SIDDIQUI MD

Table of content: ASMA A SIDDIQUI MD (NPI 1720074297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720074297 NPI number — ASMA A SIDDIQUI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIDDIQUI
Provider First Name:
ASMA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AHMED
Provider Other First Name:
ASMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720074297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N SHADELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-4959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N SENATE BLVD
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-962-5820
Provider Business Practice Location Address Fax Number:
317-962-3916
Provider Enumeration Date:
09/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  24106 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 01071023A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 347459107 . This is a "DOL" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200037120A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201065840 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248430301 . This is a "MEDICARE ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 7735593 . This is a "AETNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".