Provider Demographics
NPI:1417952623
Name:SIDDIQUI, ASHFAQ H (MD FACS)
Entity Type:Individual
Prefix:
First Name:ASHFAQ
Middle Name:H
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:309 REGENCY PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-225-2716
Mailing Address - Fax:817-225-2719
Practice Address - Street 1:309 REGENCY PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-225-2716
Practice Address - Fax:817-225-2719
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL55622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1488594OtherAETNA
TXP00439527OtherRR MEDICARE
TX0057PAOtherBCBS
TXP00439527OtherMEDICARE RR
TX1919615Medicaid
TXP00439527OtherRR MEDICARE
TXP00439527OtherMEDICARE RR