Healthcare Provider Details

I. General information

NPI: 1457705196
Provider Name (Legal Business Name): MARIUM SIDDIQI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 W UNIVERSITY DR # 100
MCKINNEY TX
75069-3445
US

IV. Provider business mailing address

PO BOX 360541
PITTSBURGH PA
15251-6541
US

V. Phone/Fax

Practice location:
  • Phone: 972-525-9900
  • Fax: 469-333-7988
Mailing address:
  • Phone: 972-525-9900
  • Fax: 469-333-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS4688
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: