Healthcare Provider Details

I. General information

NPI: 1649614462
Provider Name (Legal Business Name): JAVED SYED IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 CENTRAL AVE
COLUMBUS IN
47203-1851
US

IV. Provider business mailing address

100 S ROSENBERGER AVE STE B100
EVANSVILLE IN
47712-6507
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48399
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036151252
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48399
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01077273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: