Provider Demographics
NPI:1104273440
Name:CHICAGO MIDWEST GERIATRICS PHYSICIANS INC
Entity type:Organization
Organization Name:CHICAGO MIDWEST GERIATRICS PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARSHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-981-7250
Mailing Address - Street 1:2S633 BRIARCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5207
Mailing Address - Country:US
Mailing Address - Phone:630-981-7250
Mailing Address - Fax:
Practice Address - Street 1:2S633 BRIARCLIFF CT
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5207
Practice Address - Country:US
Practice Address - Phone:630-981-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107661207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty