Healthcare Provider Details

I. General information

NPI: 1891361846
Provider Name (Legal Business Name): SAFIA SIDDIQUI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 E ROOSEVELT RD
LOMBARD IL
60148-4630
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 630-387-6424
  • Fax: 630-387-6425
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151015034
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.171084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: