# BRAINDOCS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790130771
- **Authorized official:** KIRAN SIDDIQUI MD (CEO)
- **Authorized official phone:** (817) 240-0012

## Contact information

- **Practice address:** 2620 LONG PRAIRIE RD, \#100, FLOWER MOUND, TX 75022
- **Practice address phone:** (817) 240-0012
- **Practice address fax:** (972) 724-2111
- **Mailing address:** P.O. BOX 941927, PLANO, TX 75094-1927
- **Mailing address phone:** (817) 240-0012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/27/2016
- **Last updated:** 06/09/2022