MEDICARE: MR. IQBAL A CHOUDHRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0203X	Pediatric Critical Care Medicine Physician	35037288	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598771388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IQBAL A CHOUDHRY MD

Provider Business Mailing Address
First Line	:	4848 HIGBEE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2528
Country	:	US
Telephone Number	:	330-492-7827
Fax Number	:	330-492-7577

Provider Business Practice Location Address
First Line	:	4848 HIGBEE AVENUE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2528
Country	:	US
Telephone Number	:	330-492-7827
Fax Number	:	330-492-7577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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