Healthcare Provider Details

I. General information

NPI: 1801862461
Provider Name (Legal Business Name): SHAMIM SADIQ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W PARK ST
URBANA IL
61801-2334
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3909
US

V. Phone/Fax

Practice location:
  • Phone: 217-337-2073
  • Fax: 217-366-6106
Mailing address:
  • Phone: 217-366-1326
  • Fax: 217-366-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036112752
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036112752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: