Healthcare Provider Details

I. General information

NPI: 1427561844
Provider Name (Legal Business Name): FRAAZ M SIDDIQUI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 RYAN PKWY
ALGONQUIN IL
60102-4530
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-9555
  • Fax: 847-658-2167
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209016832
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-016832
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier209-016832
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerANP LICENSE NUMBER
# 2
Identifier041-420139
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerRN LICENSE NUMBBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: