| Shafi Siddiqi Md A Professional Corporation | |
|
31569 Canyon Estates Dr Ste 201 Lake Elsinore CA 92532-0475 | |
| (951) 226-0866 | |
| (951) 226-0868 |
| Full Name | Shafi Siddiqi Md A Professional Corporation |
|---|---|
| Speciality | General Practice |
| Location | 31569 Canyon Estates Dr Ste 201, Lake Elsinore, California |
| Authorized Official Name and Position | Brigette Jackson (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9516670817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shafi Siddiqi Md A Professional Corporation 31569 Canyon Estates Dr Ste 201 Lake Elsinore CA 92532-0475 Ph: (951) 226-0866 | Shafi Siddiqi Md A Professional Corporation 31569 Canyon Estates Dr Ste 201 Lake Elsinore CA 92532-0475 Ph: (951) 226-0866 |
| NPI Number | 1477229995 |
|---|---|
| Provider Enumeration Date | 08/17/2021 |
| Last Update Date | 08/17/2021 |
| Medicare PECOS PAC ID | 6800293135 |
|---|---|
| Medicare Enrollment ID | O20210929000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477229995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Shafi Ullah Siddiqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538499470 PECOS PAC ID: 4385937929 Enrollment ID: I20160720000945 |
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