Provider Demographics
NPI:1508893702
Name:SIDDIQI, ATHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHER
Middle Name:A
Last Name:SIDDIQI
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 1:17521 ST LUKES WAY
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8039
Mailing Address - Country:US
Mailing Address - Phone:936-266-4330
Mailing Address - Fax:281-364-0028
Practice Address - Street 1:17198 ST LUKES WAY STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8013
Practice Address - Country:US
Practice Address - Phone:936-266-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9905207R00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143937OtherMEDICARE PTAN
TXTXB148263OtherMEDICARE PTAN
TX1057911111Medicaid
TX105791110Medicaid
TXTXB143927OtherMEDICARE PTAN
TX105791110Medicaid
TX8G8816Medicare PIN