Healthcare Provider Details

I. General information

NPI: 1821075797
Provider Name (Legal Business Name): NASIR IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/19/2021
Certification Date: 12/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 IVY LN
OAK BROOK IL
60523-1738
US

IV. Provider business mailing address

25 IVY LN
OAK BROOK IL
60523-1738
US

V. Phone/Fax

Practice location:
  • Phone: 630-862-5616
  • Fax:
Mailing address:
  • Phone: 630-862-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-103899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: