Healthcare Provider Details

I. General information

NPI: 1407975584
Provider Name (Legal Business Name): ASIF MOHAMMED SIDDIQUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 EXECUTIVE CENTER DR STE. 216
AUSTIN TX
78731-1643
US

IV. Provider business mailing address

3636 EXECUTIVE CENTER DR STE. 216
AUSTIN TX
78731-1643
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-4445
  • Fax: 512-335-4099
Mailing address:
  • Phone: 512-334-4445
  • Fax: 512-335-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberL0600
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL0600
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberL0600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: