Healthcare Provider Details

I. General information

NPI: 1255487641
Provider Name (Legal Business Name): OMNI HEALTH.P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W LAWRENCE AVE UNIT# C
CHICAGO IL
60625-2958
US

IV. Provider business mailing address

2501 W LAWRENCE AVE UNIT# C
CHICAGO IL
60625-2958
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3344
  • Fax: 773-989-8458
Mailing address:
  • Phone: 773-989-3344
  • Fax: 773-989-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ZAKI A SIDDIQUI
Title or Position: MD
Credential: M.D.
Phone: 773-989-3344