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General NPI Number Information
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NPI Number | 1235584541
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Entity Type | Individual
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Provider Name | AHMED FARAZ SIDDIQUI D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 1426 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-1821
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Country | US
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Telephone | 312-829-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 1426 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-1821
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Country | US
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Telephone | 312-829-1424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02005873A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036148488
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License Number State | IL
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