Provider Demographics
NPI:1578745576
Name:SIDDIQUI, MASOOD (MBA)
Entity Type:Individual
Prefix:
First Name:MASOOD
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1735
Mailing Address - Country:US
Mailing Address - Phone:773-262-4432
Mailing Address - Fax:773-262-4712
Practice Address - Street 1:7455 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1735
Practice Address - Country:US
Practice Address - Phone:773-262-4432
Practice Address - Fax:773-262-4712
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208285Medicare PIN
IL211529Medicare PIN