Provider Demographics
NPI:1154636561
Name:SIDDIQUI, KASHIF AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:KASHIF
Middle Name:AHMED
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 BARTON SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3952
Mailing Address - Country:US
Mailing Address - Phone:832-462-9574
Mailing Address - Fax:281-786-3939
Practice Address - Street 1:11601 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE # 111-139
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7283
Practice Address - Country:US
Practice Address - Phone:832-462-9574
Practice Address - Fax:281-786-3939
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27031207Q00000X, 390200000X
TXP2788207Q00000X, 207RG0300X, 207P00000X
TXBP10034162390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program