Lake Havasu Primary Care PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

48667 Issued in AZ

Legal business name

LAKE HAVASU PRIMARY CARE PLLC

Practice address

1830 Mesquite Ave
Suite B
Lake Havasu City, AZ 86403-5885

Phone

(928) 453-0777

Fax

(928) 453-0778

NPI assigned

Feb 11, 2015

Last updated

Feb 11, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Essa J Sidiqi, M.D.NPI 1891008934

Title

Owner/Member/Manager

Phone

(928) 453-0777

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Essa J. Sidiqi, M.D.

  • Family Medicine Physician
  • Wayne, MI
  • NPI 1891008934

  AZ

  Medicare reassignment NPD Authorized official
• Ibrahim H Sidiqi, MD

  • Interventional Cardiology Physician
  • Phoenix, AZ
  • NPI 1649470071

  Internal Medicine

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1194116186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 MESQUITE AVE",
            "address_2": "SUITE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035885",
            "telephone_number": "928-453-0777",
            "fax_number": "928-453-0778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 MESQUITE AVE",
            "address_2": "SUITE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035885",
            "telephone_number": "928-453-0777",
            "fax_number": "928-453-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HAVASU PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "SIDIQI",
        "authorized_official_first_name": "ESSA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/MEMBER/MANAGER",
        "authorized_official_telephone_number": "928-453-0777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "48667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PLLC REGISTRATION NUMBER",
            "identifier": "P-1982371-1",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Havasu Imaging Center Inc
• Lake Havasu Medical Laboratory,LTD.
• Lake Havasu OB-GYN Care LLC
• Lake Havasu OB/GYN, PC
• Lake Havasu Orthodontics LLC
• Lake Havasu Radiology, PLLC
• Lake Havasu Too, LLC (Prestige Assisted Living at Claremont)
• Lake Havasu Unified School Distrct
• Lake Havasu Unified School District #1
• Lake View Terrace Management LLC

• Internal Medicine Physician in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.