Healthcare Provider Details

I. General information

NPI: 1639261696
Provider Name (Legal Business Name): IQBAL NASIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18161 W 13 MILE RD SUITE D4
SOUTHFIELD MI
48076-1113
US

IV. Provider business mailing address

18161 W 13 MILE RD SUITE D4
SOUTHFIELD MI
48076-1113
US

V. Phone/Fax

Practice location:
  • Phone: 248-901-1111
  • Fax: 248-901-4444
Mailing address:
  • Phone: 248-901-1111
  • Fax: 248-901-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301039377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: