Provider Demographics
NPI:1811978000
Name:SIDDIQI, MUHAMMAD A (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:A
Last Name:SIDDIQI
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:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-460-9836
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:333 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1748
Practice Address - Country:US
Practice Address - Phone:708-756-0100
Practice Address - Fax:708-709-6353
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082118207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4673170001OtherDMERC
IL036082118Medicaid
ILP00444355OtherRAILROAD MEDICARE
IL060064194OtherRR MEDICARE
K48435/203979Medicare PIN
ILK06300Medicare PIN
ILP00444355OtherRAILROAD MEDICARE
IL060064194OtherRR MEDICARE