Basic Information
| Provider Information | |||||||||
| NPI: | 1134169717 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIDDIQI | ||||||||
| FirstName: | MOHAMED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 E 22ND ST | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601486110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308742542 | ||||||||
| FaxNumber: | 6308742642 | ||||||||
| Practice Location | |||||||||
| Address1: | 5645 W. ADDISON STREET | ||||||||
| Address2: | OUR LADY OF THE RESURRECTION HOSPITAL | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732827000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.