Provider Demographics
NPI:1164474102
Name:SADIQ, SHEIKH M (MD)
Entity type:Individual
Prefix:
First Name:SHEIKH
Middle Name:M
Last Name:SADIQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MEMORIAL DRIVE
Mailing Address - Street 2:MEMORIAL HOSPITAL MEDICAL AFFAIRS CREDENTIALING DEPT
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-257-4644
Mailing Address - Fax:
Practice Address - Street 1:4550 MEMORIAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5372
Practice Address - Country:US
Practice Address - Phone:618-257-4243
Practice Address - Fax:618-257-4838
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361146122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361146121Medicaid
IL0361146121Medicaid
IL0361146121Medicaid