Healthcare Provider Details

I. General information

NPI: 1376612630
Provider Name (Legal Business Name): MUHAMMAD Y SIDDIQ SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 FOX VALLEY CENTER DR, UNIT 3
AURORA IL
60504-4108
US

IV. Provider business mailing address

4075 FOX VALLEY CENTER DR, UNIT 3
AURORA IL
60504-4108
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-1111
  • Fax: 630-978-1180
Mailing address:
  • Phone: 630-978-1111
  • Fax: 630-978-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MUHAMMAD Y SIDDIQ
Title or Position: OWNER
Credential: M.D.
Phone: 630-553-2545