Provider Demographics
NPI:1144439456
Name:SIDDIQUE, MOHAMMAD TABRAIZE (M D)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:TABRAIZE
Last Name:SIDDIQUE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8132
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:2655 WARRENVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5646
Practice Address - Country:US
Practice Address - Phone:866-949-0108
Practice Address - Fax:901-436-1384
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117676207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100323989OtherGROUP MEDICARE PTAN
IL208341Medicare PIN
IL208342Medicare PIN
ILF100323989OtherGROUP MEDICARE PTAN