Provider Demographics
NPI:1124097951
Name:SIDDIQUI, AKHTAR K (MD)
Entity type:Individual
Prefix:DR
First Name:AKHTAR
Middle Name:K
Last Name:SIDDIQUI
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 1:2040 OGDEN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7208
Mailing Address - Country:US
Mailing Address - Phone:630-499-7500
Mailing Address - Fax:630-898-3970
Practice Address - Street 1:2040 OGDEN AVE STE 401
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7208
Practice Address - Country:US
Practice Address - Phone:630-499-7500
Practice Address - Fax:630-898-3970
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065744207R00000X, 207RC0200X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065744Medicaid
ILL33155Medicare PIN