Provider Demographics
NPI:1326083072
Name:SIDDIQ, ZAKARIA (MD)
Entity Type:Individual
Prefix:
First Name:ZAKARIA
Middle Name:
Last Name:SIDDIQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851378
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1378
Mailing Address - Country:US
Mailing Address - Phone:972-288-1038
Mailing Address - Fax:972-285-9530
Practice Address - Street 1:1050 N BELT LINE
Practice Address - Street 2:SUITE 103
Practice Address - City:MESZUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-288-1038
Practice Address - Fax:972-285-9530
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK63262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56437Medicare UPIN