Basic Information
| Provider Information | |||||||||
| NPI: | 1407293202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | FAISAL | ||||||||
| MiddleName: | RAB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 SHADOW CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134424997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4003 CREEKSIDE LOOP | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989083962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092483263 | ||||||||
| FaxNumber: | 5092252702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ML60375701 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | T5668 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60577168 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2029856 | 05 | WA | MEDICAID |