Healthcare Provider Details

I. General information

NPI: 1366534729
Provider Name (Legal Business Name): ZAKI A SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 W LAWRENCE AVE
CHICAGO IL
60625-3679
US

IV. Provider business mailing address

2515 W LAWRENCE AVE
CHICAGO IL
60625-3679
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 Number036100955
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: