Basic Information
| Provider Information | |||||||||
| NPI: | 1467896043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BATOOL | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097724182 | ||||||||
| FaxNumber: | 2813370816 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 GULF FWY S STE 6 | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325052250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2013 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | Q9738 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 207R00000X | Q9738 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 372462703 | 05 | TX | MEDICAID |