Provider Demographics
NPI:1366534729
Name:SIDDIQUI, ZAKI A (MD)
Entity type:Individual
Prefix:
First Name:ZAKI
Middle Name:A
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 1:2515 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3679
Mailing Address - Country:US
Mailing Address - Phone:773-989-3344
Mailing Address - Fax:773-989-8458
Practice Address - Street 1:2515 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3679
Practice Address - Country:US
Practice Address - Phone:773-989-3344
Practice Address - Fax:773-989-8458
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH31081Medicare UPIN