Healthcare Provider Details

I. General information

NPI: 1619965258
Provider Name (Legal Business Name): SHAHID IQBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 TENNESSEE AVE
CHATTANOOGA TN
37409
US

IV. Provider business mailing address

3319 FOREST SHADOWS DR
CHATTANOOGA TN
37421-2801
US

V. Phone/Fax

Practice location:
  • Phone: 423-821-1177
  • Fax: 423-821-1188
Mailing address:
  • Phone: 423-892-0680
  • Fax: 423-821-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGA53071
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: