Provider Demographics
NPI:1235430851
Name:SIGNATURE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SIGNATURE MEDICAL GROUP, INC
Other - Org Name:PRIMARY CARE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUMANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-258-4978
Mailing Address - Street 1:2010 S ARLINGTON HEIGHTS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4100
Mailing Address - Country:US
Mailing Address - Phone:847-258-4978
Mailing Address - Fax:877-701-6974
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4100
Practice Address - Country:US
Practice Address - Phone:847-258-4978
Practice Address - Fax:877-701-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124650Medicaid
IL036124650Medicaid