Healthcare Provider Details

I. General information

NPI: 1780069161
Provider Name (Legal Business Name): IQBAL PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 GRUPP RD UNIT 31035
SAINT LOUIS MO
63131-5002
US

IV. Provider business mailing address

1015 GRUPP RD UNIT 31035
SAINT LOUIS MO
63131-5002
US

V. Phone/Fax

Practice location:
  • Phone: 314-799-8075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2006023682
License Number StateMO

VIII. Authorized Official

Name: SHERIFA IQBAL
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 314-799-8075