Provider Demographics
NPI:1336320506
Name:SIDDIQUI, ADNAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:
Last Name:SIDDIQUI
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 1:601 RIVER POINTE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2945
Mailing Address - Country:US
Mailing Address - Phone:936-441-5550
Mailing Address - Fax:
Practice Address - Street 1:601 RIVER POINTE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2945
Practice Address - Country:US
Practice Address - Phone:936-539-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429213207R00000X
TXN3309207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206615101Medicaid
TXTXB124478Medicare PIN
TX206615101Medicaid