Provider Demographics
NPI:1205819091
Name:SAMIUDDIN, ZISHAN A (MD)
Entity Type:Individual
Prefix:
First Name:ZISHAN
Middle Name:A
Last Name:SAMIUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZISHAN
Other - Middle Name:
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:
Practice Address - Street 1:1415 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:281-420-8400
Practice Address - Fax:713-523-4897
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ22982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1220675-02Medicaid
TX245910OtherVALUE OPTIONS
TX209743000OtherMAGELLAN
TX189310160775OtherHUMANA
5038645OtherAETNA
TX1220675-02OtherBLUE CROSS/BLUE SHIELD
TX189310160775OtherHUMANA
TX245910OtherVALUE OPTIONS
TXG20642Medicare UPIN