MEDICARE: DR. SHARIQ IQBAL CHUDHRI D.O.

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	207R00000X	Internal Medicine Physician	S0861	TX
2	207R00000X	Internal Medicine Physician	006359	AZ
3	207RR0500X	Rheumatology Physician	006359	AZ
4	207RR0500X	Rheumatology Physician	S0861	TX

General Provider Information

NPI Number	:	1710277751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARIQ IQBAL CHUDHRI D.O.

Provider Business Mailing Address
First Line	:	5450 CLEARFORK MAIN ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3562
Country	:	US
Telephone Number	:	817-336-7191
Fax Number	:	817-877-4015

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3562
Country	:	US
Telephone Number	:	817-336-7191
Fax Number	:	817-877-4015

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

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	09/03/2021

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