MEDICARE: MEDICAL CENTER PULMONARY CONSULTANT LLC

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	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1356845929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER PULMONARY CONSULTANT LLC

Provider Business Mailing Address
First Line	:	PO BOX 540088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0088
Country	:	US
Telephone Number	:	713-850-1190
Fax Number	:	713-850-1327

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2321
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2723
Country	:	US
Telephone Number	:	713-795-5155
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ATIF SIDDIQUI
Credential	:	MD
Telephone Number	:	713-795-5155

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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