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NPI Code Detail

MEDICARE: OMAR MOHAMMED SIDDIQUI M.D.

MEDICARE: OMAR MOHAMMED 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
1207RI0011XInterventional Cardiology Physician036149859IL
2207R00000XInternal Medicine Physician125069011IL
3207R00000XInternal Medicine Physician036149859IL
4207R00000XInternal Medicine Physician57248471OH
5207RC0000XCardiovascular Disease Physician036149859IL

General Provider Information

NPI Number : 1467803122
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAR MOHAMMED SIDDIQUI M.D.
Provider Business Mailing Address
First Line : 460 PRINCE VALIANT LN
Second Line :
City : BOURBONNAIS
State : IL
Zip : 60914-9333
Country : US
Telephone Number : 224-619-2205
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-7603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2016
Last Update Date : 05/27/2026

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