Basic Information
| Provider Information | |||||||||
| NPI: | 1427269000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDALL | ||||||||
| FirstName: | SIMONA | ||||||||
| MiddleName: | JOFFE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4108 N WOLCOTT AVE | ||||||||
| Address2: | APT 1 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606131845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126237916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198361600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 03/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 125055501 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35.090861 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.