Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036122637 | IL |
N | 207Q00000X | Family Doctor | 125052070 | IL |
NPI | 1003063264 |
---|---|
Provider Name | Juwaria O Siddiqui |
First Address | Lincolnwood, IL 60712-3925 |
Second Address | Lincolnwood, IL 60712-3925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 12/11/2019 |