| Mohammad Siddiqui Md Ltd | |
|
9669 Kenton Ave Ste 404 Skokie IL 60076-1266 | |
| (847) 679-6333 | |
| (847) 679-6343 |
| Full Name | Mohammad Siddiqui Md Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 9669 Kenton Ave, Skokie, Illinois |
| Authorized Official Name and Position | Mohammad Siddiqui (MD) |
| Authorized Official Contact | 8476796333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mohammad Siddiqui Md Ltd 9669 Kenton Ave Ste 404 Skokie IL 60076-1266 Ph: (847) 679-6333 | Mohammad Siddiqui Md Ltd 9669 Kenton Ave Ste 404 Skokie IL 60076-1266 Ph: (847) 679-6333 |
| NPI Number | 1467877605 |
|---|---|
| Provider Enumeration Date | 02/25/2014 |
| Last Update Date | 02/25/2014 |
| Medicare PECOS PAC ID | 4789816208 |
|---|---|
| Medicare Enrollment ID | O20140416001428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467877605 | NPI | - | NPPES |
| 036093190 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohammad A Siddiqui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487630513 PECOS PAC ID: 3274674874 Enrollment ID: I20100127000371 |
| Provider Name | Katie Dcruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124412168 PECOS PAC ID: 0941513642 Enrollment ID: I20150724010096 |
| Provider Name | Amit Gandhi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548711971 PECOS PAC ID: 1850679267 Enrollment ID: I20161104001108 |
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