Provider Demographics
NPI:1932180296
Name:SIDDIQI, ADILA NIGHAT (DO)
Entity type:Individual
Prefix:
First Name:ADILA
Middle Name:NIGHAT
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 SHERMAN DR #A
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1027
Mailing Address - Country:US
Mailing Address - Phone:972-647-0550
Mailing Address - Fax:972-647-1010
Practice Address - Street 1:2771 SHERMAN DR #A
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1027
Practice Address - Country:US
Practice Address - Phone:972-647-0550
Practice Address - Fax:972-647-1010
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076ECOtherBCBS PCP PROVIDER#
TX121398502Medicaid
TX00828JMedicare PIN
TX121398502Medicaid