Healthcare Provider Details

I. General information

NPI: 1841712999
Provider Name (Legal Business Name): SHUMAILA MUHAMMAD IQBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 09/25/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 RIETH BLVD STE 104
GOSHEN IN
46526-5869
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-389-5540
  • Fax:
Mailing address:
  • Phone: 574-647-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01089825A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01089825A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: