MEDICARE: SIDDIKA BARKAT RDN, LDN, MSC

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	133V00000X	Registered Dietitian	164.023118	IL

General Provider Information

NPI Number	:	1619837937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDDIKA BARKAT RDN, LDN, MSC

Provider Business Mailing Address
First Line	:	6239 PINE TREE DR
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6239 PINE TREE DR
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5176
Country	:	US
Telephone Number	:	224-475-9896
Fax Number	:

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

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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