Provider Demographics
NPI:1598819575
Name:SIDDIQUI, SABET (MD)
Entity Type:Individual
Prefix:
First Name:SABET
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTH SERVICES DR STE 5
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9601
Mailing Address - Country:US
Mailing Address - Phone:815-756-5255
Mailing Address - Fax:815-756-9944
Practice Address - Street 1:9 HEALTH SERVICES DR STE 5
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9601
Practice Address - Country:US
Practice Address - Phone:815-756-5255
Practice Address - Fax:815-756-9944
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086894207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL069837OtherHEALTH ALLIANCE
IL036086894Medicaid
ILL82593Medicare PIN
IL036086894Medicaid
ILF76450Medicare UPIN