Provider Demographics
NPI:1548536469
Name:SIDDIQUI, IFTEQUAR AHMED (MD, PHARMD)
Entity type:Individual
Prefix:DR
First Name:IFTEQUAR
Middle Name:AHMED
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 E BELL RD
Mailing Address - Street 2:STE 107 BOX 468
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2189
Mailing Address - Country:US
Mailing Address - Phone:480-325-9600
Mailing Address - Fax:480-493-5336
Practice Address - Street 1:5355 E ERICKSON DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2826
Practice Address - Country:US
Practice Address - Phone:520-324-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA141107207L00000X
AZ54364208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318631Medicaid