Provider Demographics
NPI:1003878299
Name:SIDDIQI, AYESHA (MD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:F
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:PO BOX 809094
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9094
Mailing Address - Country:US
Mailing Address - Phone:312-236-3642
Mailing Address - Fax:312-236-5162
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-236-3642
Practice Address - Fax:312-236-5162
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087798207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087798Medicaid