Provider Demographics
NPI:1467614768
Name:HAROON SIDDIQUE, MD, PA
Entity Type:Organization
Organization Name:HAROON SIDDIQUE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-626-1848
Mailing Address - Street 1:1816 S FM 51
Mailing Address - Street 2:SUITE 400, #130
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3784
Mailing Address - Country:US
Mailing Address - Phone:940-626-1848
Mailing Address - Fax:940-626-1849
Practice Address - Street 1:902 PRESKITT RD STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-4101
Practice Address - Country:US
Practice Address - Phone:940-626-1848
Practice Address - Fax:940-626-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM63972084P0800X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015RTOtherBCBS
TX191149703Medicaid
TX200570401Medicaid