Provider Demographics
NPI:1134321649
Name:SOHAIL R. SIDDIQUI,M.D.,P.A.
Entity Type:Organization
Organization Name:SOHAIL R. SIDDIQUI,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:281-634-7800
Mailing Address - Street 1:15200 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3863
Mailing Address - Country:US
Mailing Address - Phone:281-265-1717
Mailing Address - Fax:
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-634-7800
Practice Address - Fax:281-634-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208324801Medicaid
TX208324801Medicaid