Healthcare Provider Details

I. General information

NPI: 1205316908
Provider Name (Legal Business Name): MAHRUKH SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 RANDALL RD
SOUTH ELGIN IL
60177-3315
US

IV. Provider business mailing address

552 RANDALL RD
SOUTH ELGIN IL
60177-3315
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-6700
  • Fax: 630-315-6699
Mailing address:
  • Phone: 630-315-6700
  • Fax: 630-315-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036153913
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.072841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: