Provider Demographics
NPI:1225148000
Name:SIDDIQI, ALIA NASRIN (MD)
Entity Type:Individual
Prefix:MS
First Name:ALIA
Middle Name:NASRIN
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:773-561-1574
Mailing Address - Fax:773-564-5215
Practice Address - Street 1:5310 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2514
Practice Address - Country:US
Practice Address - Phone:773-561-1574
Practice Address - Fax:773-564-5215
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052692207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052692Medicaid
IL487720Medicare ID - Type Unspecified
D12999Medicare UPIN