| Doctor Name: | SURAIYA SIDDIQUE |
| NPI Number: | 1295976330 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 52375-020 |
| Business Practice Address: | 600 N Main St Mount Vernon, MO - 657121004 |
| Business Phone Number: | 4174664000 |
| Business Fax Number: | |
| Mailing Address: | 1701 Westpark Dr, #113 LITTLE ROCK |
| State: | AR |
| Postal Code: | 722042565 |
| Phone Number: | 5016033466 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2009 |
| NPI Last Update Date: | 03/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 52375-020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |