Provider Demographics
NPI:1528593845
Name:SIDDIQI, IMAAD (MD)
Entity Type:Individual
Prefix:
First Name:IMAAD
Middle Name:
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 1:4191 BELLAIRE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1003
Mailing Address - Country:US
Mailing Address - Phone:346-356-7000
Mailing Address - Fax:346-356-7001
Practice Address - Street 1:4191 BELLAIRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1003
Practice Address - Country:US
Practice Address - Phone:346-356-7000
Practice Address - Fax:346-356-7001
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine