Provider Demographics
NPI:1255601852
Name:FAZILA SIDDIQI MD . PA
Entity type:Organization
Organization Name:FAZILA SIDDIQI MD . PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAZILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-491-1618
Mailing Address - Street 1:2300 W. WHITE AVE.
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:214-491-1618
Mailing Address - Fax:214-491-6155
Practice Address - Street 1:2300 W. WHITE AVE.
Practice Address - Street 2:SUITE # 101
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:214-491-1618
Practice Address - Fax:214-491-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK34672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0304347-01Medicaid
TXG56256Medicare UPIN