Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-122458 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036-122458 | IL |
NPI | 1992770101 |
---|---|
Provider Name | Sohail Abid Siddique |
First Address | Springfield, IL 62702-5303 |
Second Address | Springfield, IL 62702-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036122458 | (05) | IL |