| Broadway Family Clinic | |
|
2405 Barton Shore Dr Pearland TX 77584-3952 | |
| (832) 462-9574 | |
| Not Available |
| Full Name | Broadway Family Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2405 Barton Shore Dr, Pearland, Texas |
| Authorized Official Name and Position | Kashif Ahmed Siddiqui (OWNER) |
| Authorized Official Contact | 8324629574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Family Clinic 2405 Barton Shore Dr Pearland TX 77584-3952 Ph: (832) 462-9574 | Broadway Family Clinic 2405 Barton Shore Dr Pearland TX 77584-3952 Ph: (832) 462-9574 |
| NPI Number | 1821604000 |
|---|---|
| Provider Enumeration Date | 09/22/2020 |
| Last Update Date | 03/24/2021 |
| Medicare PECOS PAC ID | 7719394295 |
|---|---|
| Medicare Enrollment ID | O20210330000166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821604000 | NPI | - | NPPES |
| P2788 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| Provider Name | Kashif Ahmed Siddiqui |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154636561 PECOS PAC ID: 5092977066 Enrollment ID: I20120509000177 |
| Provider Name | Sumera Muzaffar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346478419 PECOS PAC ID: 2961791447 Enrollment ID: I20160523002539 |
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