Healthcare Provider Details

I. General information

NPI: 1265895247
Provider Name (Legal Business Name): HINA SIDDIQUI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 E MAIN ST STE 190
ST CHARLES IL
60174-2463
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-3328
US

V. Phone/Fax

Practice location:
  • Phone: 630-348-3100
  • Fax: 630-513-0727
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.148796
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036148796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: