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General NPI Number Information
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NPI Number | 1659685873
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Entity Type | Organization
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Legal Business Name | ALIA SIDDIQI,M.D,S.C
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 4646 N MARINE DR STE 5500A
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City | CHICAGO
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State | IL
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Zip | 60640-5759
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Country | US
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Telephone | 773-561-1574
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Fax | 773-564-5829
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Provider Business Mailing Address
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Address Line | 7017 N KILBOURN AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2216
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Country | US
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Telephone | 847-673-8459
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Fax | 773-564-5829
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALIA SIDDIQI
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Credential | M.D
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Telephone | 773-561-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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