Active NPI
MD Neurodiagnostic MGT SVCS Inc
- Neurology Physician
- Lewisville, TX
National Provider Identifier
1114478849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- CA129953
- Legal business name
- MD NEURODIAGNOSTIC MGT SVCS INC
- Practice address
- 2781 Ithaca Place
Lewisville, TX 75067 - Phone
- (702) 530-7492
- Fax
- (877) 705-3046
- NPI assigned
- Oct 18, 2016
- Last updated
- Nov 15, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Adam A Siddiqui
- Title
- Ceo/President
- Phone
- (214) 972-8151
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | CA129953 | CA | Primary |
| Clinical Neurophysiology Physician | 2084N0600X | ME94218 | FL |
Addresses
Primary practice location
2781 Ithaca Place
Lewisville, TX 75067
Mailing address
PO Box 297
Coppell, TX 75019
Phone (702) 530-7492
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30990Z | Other | FL | 30990Z |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Electroneurodiagnostic Specialist/Technologist
- Simi Valley, CA
- NPI 1285933416
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731628800000",
"number": "1114478849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 297",
"city": "COPPELL",
"state": "TX",
"postal_code": "75019",
"telephone_number": "702-530-7492",
"fax_number": "877-705-3046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2781 ITHACA PLACE",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "75067",
"telephone_number": "702-530-7492",
"fax_number": "877-705-3046"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MD NEURODIAGNOSTIC MGT SVCS INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-10-18",
"last_updated": "2024-11-15",
"status": "A",
"authorized_official_last_name": "SIDDIQUI",
"authorized_official_first_name": "ADAM",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "214-972-8151",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "CA129953",
"primary": true
},
{
"code": "2084N0600X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": "FL",
"license": "ME94218",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "30990Z",
"identifier": "30990Z",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.