Healthcare Provider Details

I. General information

NPI: 1235533886
Provider Name (Legal Business Name): WILLOWBROOK SPINE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 WESTHEIMER RD SUITE 2
HOUSTON TX
77063-3414
US

IV. Provider business mailing address

9400 WESTHEIMER RD SUITE 2
HOUSTON TX
77063-3414
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberM0921
License Number StateTX

VIII. Authorized Official

Name: DR. SAQIB SIDDIQUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 832-547-0927