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General NPI Number Information
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NPI Number | 1780069161
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Entity Type | Organization
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Legal Business Name | IQBAL PSYCHIATRY
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 1015 GRUPP RD UNIT 31035
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City | SAINT LOUIS
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State | MO
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Zip | 63131-5002
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Country | US
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Telephone | 314-799-8075
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 GRUPP RD UNIT 31035
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City | SAINT LOUIS
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State | MO
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Zip | 63131-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | SHERIFA IQBAL
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Credential | MD
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Telephone | 314-799-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2006023682
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License Number State | MO
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