MEDICARE: SHUMAILA MUHAMMAD IQBAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01089825A	IN
2	207RR0500X	Rheumatology Physician	01089825A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841712999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUMAILA MUHAMMAD IQBAL

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 RIETH BLVD STE 104
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-5869
Country	:	US
Telephone Number	:	574-389-5540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	09/25/2023

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