Provider Demographics
NPI:1891244331
Name:M SIDDHAPPAN MD PA
Entity Type:Organization
Organization Name:M SIDDHAPPAN MD PA
Other - Org Name:M SIDDHAPPAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MURUGESAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDHAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-830-7768
Mailing Address - Street 1:4760 PRESTON RD
Mailing Address - Street 2:STE 244-244
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8548
Mailing Address - Country:US
Mailing Address - Phone:425-830-7768
Mailing Address - Fax:940-387-9924
Practice Address - Street 1:2210 SAN JACINTO BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7527
Practice Address - Country:US
Practice Address - Phone:425-830-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M SIDDHAPPAN MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty