MEDICARE: DR. SUHAIL A SIDDIQUI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036092442	IL
2	207RI0200X	Infectious Disease Physician	036092442	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316904279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUHAIL A SIDDIQUI M.D.

Provider Business Mailing Address
First Line	:	6300 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1204
Country	:	US
Telephone Number	:	773-681-0260
Fax Number	:	773-681-0260

Provider Business Practice Location Address
First Line	:	6300 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1204
Country	:	US
Telephone Number	:	773-681-0260
Fax Number	:	773-346-1239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/17/2024

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