| Doctor Name: | DR. MOHAMED SIDDIQUE |
| NPI Number: | 1114086857 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 4301047009 |
| Business Practice Address: | 9315 Telegraph Redford, MI - 48239 |
| Business Phone Number: | 3134504500 |
| Business Fax Number: | 3134504514 |
| Mailing Address: | 6286 Timberwood, WEST BLOOMFIELD |
| State: | MI |
| Postal Code: | 48322 |
| Phone Number: | 3136618151 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | 4301047009 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |