Provider Demographics
NPI:1427561844
Name:SIDDIQUI, FRAAZ M (APN)
Entity Type:Individual
Prefix:
First Name:FRAAZ
Middle Name:M
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1345 RYAN PKWY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4530
Practice Address - Country:US
Practice Address - Phone:847-658-9555
Practice Address - Fax:847-658-2167
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016832363LP2300X
IL209-016832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-016832OtherANP LICENSE NUMBER
IL041-420139OtherRN LICENSE NUMBBER