Healthcare Provider Details

I. General information

NPI: 1922361773
Provider Name (Legal Business Name): MOHAMMED SALMAN SIDDIQUI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 09/11/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 AURORA AVE
NAPERVILLE IL
60540-6210
US

IV. Provider business mailing address

1508 AURORA AVE
NAPERVILLE IL
60540-6210
US

V. Phone/Fax

Practice location:
  • Phone: 630-264-8600
  • Fax:
Mailing address:
  • Phone: 630-264-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036145623
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101019659
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number34.012434
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036.145623
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036.145623
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.145623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: