Provider Demographics
NPI:1912090572
Name:ZAIDI, SYED M (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:ZAIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 VISION PARK BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3024
Mailing Address - Country:US
Mailing Address - Phone:936-273-0836
Mailing Address - Fax:936-321-2266
Practice Address - Street 1:200 RIVER POINTE DR STE 120
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2817
Practice Address - Country:US
Practice Address - Phone:936-756-2555
Practice Address - Fax:936-756-2534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39997207R00000X
TXN1236207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100008150Medicaid
INP00413670OtherRAILROAD MEDICARE IND
KYP00408183OtherRAILROAD MEDICARE KY
IN01063002AOtherMEDICAL LICENSE
KY39997OtherMEDICAL LICENSE
IN200879190Medicaid
INP00413670OtherRAILROAD MEDICARE IND
IN01063002AOtherMEDICAL LICENSE
KYP00408183OtherRAILROAD MEDICARE KY