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General NPI Number Information
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NPI Number | 1518244573
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Entity Type | Organization
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Legal Business Name | OMNI HEALTH PC
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 2501 W LAWRENCE AVE SUITE C
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City | CHICAGO
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State | IL
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Zip | 60625-2958
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Country | US
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Telephone | 773-989-3344
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Fax | 773-989-8458
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Provider Business Mailing Address
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Address Line | 2501 W LAWRENCE AVE SUITE C
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City | CHICAGO
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State | IL
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Zip | 60625-2958
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Country | US
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Telephone | 773-989-3344
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Fax | 773-989-8458
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Authorized Official
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Title or Position | M.D
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Name | DR. ZAKI SIDDIQUI
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Credential | M.D
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Telephone | 773-989-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036122637
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | 036126888
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036100955
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License Number State | IL
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