Basic Information
| Provider Information | |||||||||
| NPI: | 1265842678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | BISMAH | ||||||||
| MiddleName: | FARRUKH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FARRUKH | ||||||||
| OtherFirstName: | BISMAH | ||||||||
| OtherMiddleName: | SABEEN | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE HOSPITAL DRIVE | ||||||||
| Address2: | DC043.00, MA 427A | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738845230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 02/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10049999 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2017028722 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.