MEDICARE: DR. SIDDHARTH R DAVE D.O.

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	K4035	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518042035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDDHARTH R DAVE D.O.

Provider Business Mailing Address
First Line	:	4131 STARBOARD SHORES DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 FM 1092 RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-1504
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/09/2023

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