Organization
DFW FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADILA NIGHAT SIDDIQI D.O. (OWNER)
(972) 647-0550
Entity
Organization
Contact information
Practice address
2771 SHERMAN ST, GRAND PRAIRIE, TX 75051-6016
(972) 647-0550
(972) 647-1010
Mailing address
2771 SHERMAN ST, GRAND PRAIRIE, TX 75051-6016
(972) 647-0550
(972) 647-1010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K7396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076EC
BLUE CROSS BLUE SHIELD OF TEXAS
TX
05
—
121398502
—
TX
01
—
OA5881
MEDICARE GROUP PTAN #
—
Enumeration date
01/14/2010
Last updated
04/23/2014
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