Provider Demographics
NPI:1659685873
Name:ALIA SIDDIQI,M.D,S.C
Entity Type:Organization
Organization Name:ALIA SIDDIQI,M.D,S.C
Other - Org Name:ALIA SIDDIQI,M.D,S.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-1574
Mailing Address - Street 1:7017 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2216
Mailing Address - Country:US
Mailing Address - Phone:847-673-8459
Mailing Address - Fax:773-564-5829
Practice Address - Street 1:4646 N MARINE DR STE 5500A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-561-1574
Practice Address - Fax:773-564-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052692Medicaid