Basic Information
| Provider Information | |||||||||
| NPI: | 1174919021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQI | ||||||||
| FirstName: | AHSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE BAYLOR PLAZA | ||||||||
| Address2: | #286A | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139487000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 ST. JOSEPH PARKWAY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137984661 | ||||||||
| FaxNumber: | 7137985838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | ME138854 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZP0105X | S9416 | TX | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.