MEDICARE: MARIAM SIDDIQI O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.011751	IL

General Provider Information

NPI Number	:	1578246716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM SIDDIQI O.D

Provider Business Mailing Address
First Line	:	1798 ARLINGTON LN
Second Line	:
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-1892
Country	:	US
Telephone Number	:	630-999-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1798 ARLINGTON LN
Second Line	:
City	:	GLENDALE HTS
State	:	IL
Zip	:	60139-1892
Country	:	US
Telephone Number	:	630-999-1799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	09/10/2025

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