Healthcare Provider Details

I. General information

NPI: 1104353614
Provider Name (Legal Business Name): IQRA IQBAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax:
Mailing address:
  • Phone: 314-251-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022003373
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2022003373
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: