Individual
DR. MUMTAZ A SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1302 FRANKLIN AVE, SUITE 4500, NORMAL, IL 61761-3551
(309) 828-1166
Mailing address
1302 FRANKLIN AVE, SUITE 4500, NORMAL, IL 61761-3551
(309) 828-1166
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732097
BCBS GROUP NUMBER
IL
01
—
212636
MEDICARE GROUP NUMBER
IL
Enumeration date
09/22/2005
Last updated
02/27/2008
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