Provider Demographics
NPI:1487715264
Name:SIDDIQUI, TAHSEEN J (M D)
Entity type:Individual
Prefix:DR
First Name:TAHSEEN
Middle Name:J
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11113 WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7611
Mailing Address - Country:US
Mailing Address - Phone:708-351-0292
Mailing Address - Fax:760-825-8825
Practice Address - Street 1:11113 WOODSTOCK DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7611
Practice Address - Country:US
Practice Address - Phone:708-351-0292
Practice Address - Fax:760-825-8825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105217207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-105217Medicaid
IL036-105217Medicaid