Provider Demographics
NPI:1598944308
Name:SIDDIQUE, MUHAMMAD ASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD ASIM
Middle Name:
Last Name:SIDDIQUE
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 1:6620 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:708-833-0318
Mailing Address - Fax:
Practice Address - Street 1:6620 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:708-833-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117530207R00000X
TXP1594207RC0200X, 207RP1001X, 207RS0012X
IL036-117530207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117530Medicaid
CA2264OtherRR GROUP #
833120OtherMEDICARE GROUP #
P00767658OtherRR INDIVIDUAL #
833120010Medicare PIN
CA2264OtherRR GROUP #
IL256510152Medicare PIN