Basic Information
| Provider Information | |||||||||
| NPI: | 1811978000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIDDIQI | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 379 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604620379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084609836 | ||||||||
| FaxNumber: | 7084601117 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604111748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087560100 | ||||||||
| FaxNumber: | 7087096353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 036082118 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 4673170001 | 01 | DMERC | OTHER | 036082118 | 05 | IL | MEDICAID | P00444355 | 01 | IL | RAILROAD MEDICARE | OTHER | 060064194 | 01 | IL | RR MEDICARE | OTHER |