DR. FAZEEL MUKHTAR SIDDIQUI (NPI# 1154513687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154513687 |
| Entity Type | Individual |
| Full Name | DR. FAZEEL MUKHTAR SIDDIQUI |
| Credential | M.D. |
| Practice Address |
751 N Rutledge St Ste 3100 Springfield IL 62702-4968 |
| Mailing Address |
Po Box 19643 Springfield IL 62794-9643 |
| Practice Telephone | 2175458000 |
| Practice Fax Number | 2175457363 |
| Mailing Telephone | 2175458000 |
| Mailing Fax Number | 2175457363 |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2020-10-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
036-132058 | IL | Allopathic & Osteopathic Physicians |
| Y | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
4301116960 | MI | Allopathic & Osteopathic Physicians |
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
036-132058 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036132058 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1221 Sixth St Ste 300, Traverse City, MI 496842360 | 2313920640 | 2313920643 |
| Street Address |
751 N RUTLEDGE ST STE 3100 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578112363 | Amanda Graham | Nurse Practitioner | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2019-09-05 |
| 1912562109 | Katie D Hartman | Nurse Practitioner | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2019-05-03 |
| 1528440724 | Jordan Leigh Sestak | Internal Medicine | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2015-06-24 |
| 1174934269 | Charlyn Fargo Ware | Dietitian, Registered | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2014-05-12 |
| 1811322209 | Nicole Lynn Atwood | Nurse Practitioner | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2013-09-04 |
| 1184979551 | Bilal Butt | Psychiatry & Neurology | 751 N Rutledge St Ste 3100, Springfield, IL 62702 | 2012-07-20 |
| 1043520869 | Jacob M Monsivais | Physician Assistant | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2010-10-14 |
| 1669784559 | Hesham A Allam | Psychiatry & Neurology | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2010-07-08 |
| 1790923951 | Nassir Hassan Monim Mansour | Neurological Surgery | 751 N Rutledge St Ste 3100, Springfield, IL 62702-4968 | 2009-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 2084V0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Vascular Neurology |
| Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437342870 | Naim Khoury | Psychiatry & Neurology | 421 N 9th St, Springfield, IL 62702-5317 | 2007-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194105056 | Sebastian Urday | Psychiatry & Neurology | 259 E Erie St Ste 1900, Chicago, IL 60611-3246 | 2015-06-05 |
| 1023403565 | Gabriela Trifan | Psychiatry & Neurology | 1740 W Taylor St, Chicago, IL 60612-7232 | 2015-04-01 |
| 1619382355 | Chike Augustine Ilorah | Psychiatry & Neurology | 3635 Vista Avenue, Desloge Tower, 14th Floor, Suite 14032, Saint Louis, IL 63110 | 2014-06-20 |
| 1962781559 | Deepa Bhupali | Psychiatry & Neurology | 1801 W Taylor St, Chicago, IL 60612-2401 | 2011-08-12 |
| 1699003418 | Qingliang Tony Wang | Psychiatry & Neurology | 611 W Park St, Neurology, Urbana, IL 61801-2529 | 2009-12-07 |
| 1699937888 | Sarah Elizabeth Parker | Psychiatry & Neurology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2008-06-28 |
| 1649340530 | Richard Ely Burgess | Psychiatry & Neurology | 1890 Silver Cross Blvd, New Lenox, IL 60451 | 2006-11-08 |
| 1669444683 | Edward M Manno | Psychiatry & Neurology | 675 N Saint Clair St, Chicago, IL 60611-5975 | 2006-02-03 |
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.