Provider Demographics
NPI:1659098234
Name:SIDDIQI, NUHA FATIMAH
Entity Type:Individual
Prefix:
First Name:NUHA
Middle Name:FATIMAH
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 S VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3405
Mailing Address - Country:US
Mailing Address - Phone:630-235-1125
Mailing Address - Fax:
Practice Address - Street 1:1101 S CANAL ST STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4940
Practice Address - Country:US
Practice Address - Phone:312-588-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist