Healthcare Provider Details

I. General information

NPI: 1801462809
Provider Name (Legal Business Name): IQBAL KARIM AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S MARIO CAPECCHI DR
SALT LAKE CITY UT
84132-0005
US

IV. Provider business mailing address

2201 BRISTOL CIRCLE SUITE 100
OAKVILLE ONTARIO
L6H 0J8
CA

V. Phone/Fax

Practice location:
  • Phone: 801-585-6622
  • Fax: 801-581-8703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3082895-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number3082895-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: