=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134613094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAANISH SIDDIQUE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2018
-----------------------------------------------------
Last Update Date | 02/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17850 KEDZIE AVE STE 3500
-----------------------------------------------------
City | HAZEL CREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60429-2082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-957-4011
-----------------------------------------------------
Fax | 708-957-4013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29373 NETWORK PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-1293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-390-5900
-----------------------------------------------------
Fax | 847-390-4757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 036.170598
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 74846-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------