Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036087798 | IL |
NPI | 1003878299 |
---|---|
Provider Name | Ayesha Siddiqi |
First Address | Chicago, IL 60680-9094 |
Second Address | Chicago, IL 60602-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 09/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036087798 | (05) | IL |