Provider Demographics
NPI:1932748415
Name:SIDDIQI, MACY CRYSTAL-BAIG (PA-C)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:CRYSTAL-BAIG
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 WESTHEIMER RD STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5277
Mailing Address - Country:US
Mailing Address - Phone:713-301-3551
Mailing Address - Fax:
Practice Address - Street 1:3720 WESTHEIMER RD STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5277
Practice Address - Country:US
Practice Address - Phone:713-301-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty