Provider Demographics
NPI:1407975584
Name:SIDDIQUI, ASIF MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:MOHAMMED
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 1:3636 EXECUTIVE CENTER DR
Mailing Address - Street 2:STE. 216
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1643
Mailing Address - Country:US
Mailing Address - Phone:512-334-4445
Mailing Address - Fax:512-335-4099
Practice Address - Street 1:3636 EXECUTIVE CENTER DR
Practice Address - Street 2:STE. 216
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1643
Practice Address - Country:US
Practice Address - Phone:512-334-4445
Practice Address - Fax:512-335-4099
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG87323Medicare UPIN