Healthcare Provider Details

I. General information

NPI: 1801187968
Provider Name (Legal Business Name): SAIFULLAH MOHAMMED SIDDIQUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST STE 202
OLYMPIA FIELDS IL
60461-1185
US

IV. Provider business mailing address

35318 EAGLE WAY
CHICAGO IL
60678-1353
US

V. Phone/Fax

Practice location:
  • Phone: 708-852-2555
  • Fax: 708-679-2223
Mailing address:
  • Phone: 708-852-2555
  • Fax: 708-679-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036135970
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036135970
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301108046
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036135970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: