Basic Information
| Provider Information | |||||||||
| NPI: | 1023404795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | IRFAN | ||||||||
| MiddleName: | HASAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4220 W 95TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604533072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083980287 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4220 W 95TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604533072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127316329 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2015 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.146952 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.