Provider Demographics
NPI:1770682338
Name:FU, SIQING (MD, PH D)
Entity Type:Individual
Prefix:
First Name:SIQING
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HOLCOMBE BLVD
Mailing Address - Street 2:UNIT 0455
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4000
Mailing Address - Country:US
Mailing Address - Phone:713-792-4318
Mailing Address - Fax:713-745-3855
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 0455
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-4318
Practice Address - Fax:713-745-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102616207RH0003X
TXM1686207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166019301Medicaid
TX166019301Medicaid
8C0483Medicare ID - Type Unspecified