Healthcare Provider Details

I. General information

NPI: 1174919021
Provider Name (Legal Business Name): AHSAN SIDDIQI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 FLOYD CURL DR
SAN ANTONIO TX
78229-3902
US

IV. Provider business mailing address

PO BOX 681149
SAN ANTONIO TX
78268-1149
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-4000
  • Fax: 210-575-6059
Mailing address:
  • Phone: 210-558-6288
  • Fax: 210-558-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01089071A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME138854
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberS9416
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: