MEDICARE: DR. KHURAM SIDDIQI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M7628	TX

General Provider Information

NPI Number	:	1093859993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHURAM SIDDIQI M.D.

Provider Business Mailing Address
First Line	:	800 BONAVENTURE WAY STE 151
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8007
Country	:	US
Telephone Number	:	346-754-3302
Fax Number	:	832-944-6219

Provider Business Practice Location Address
First Line	:	800 BONAVENTURE WAY STE 151
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8007
Country	:	US
Telephone Number	:	346-754-3302
Fax Number	:	832-944-6219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	12/11/2023

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