Healthcare Provider Details

I. General information

NPI: 1811468416
Provider Name (Legal Business Name): MUHAMMAD IQBAL PATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SW FOUNTAINVIEW BLVD STE 105
PORT SAINT LUCIE FL
34986-4527
US

IV. Provider business mailing address

1850 SW FOUNTAINVIEW BLVD STE 105
PORT SAINT LUCIE FL
34986-4527
US

V. Phone/Fax

Practice location:
  • Phone: 772-336-2818
  • Fax: 772-336-5313
Mailing address:
  • Phone: 772-336-2818
  • Fax: 772-336-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME122146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: