Healthcare Provider Details

I. General information

NPI: 1336398478
Provider Name (Legal Business Name): HALEEMA TARIQ IQBAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 700
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8648
  • Fax: 225-765-7898
Mailing address:
  • Phone: 225-765-8648
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number205383
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: