Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 036157315 | IL |
NPI | 1578055984 |
---|---|
Provider Name | Umar Kamal Siddiqui |
First Address | Oak Park, IL 60302-2519 |
Second Address | Brooklyn, NY 11212-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 12/07/2021 |