MEDICARE: GREAT HEALTH MEDICAL IOWA PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1750264156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HEALTH MEDICAL IOWA PC

Provider Business Mailing Address
First Line	:	407 WILLOUGHBY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 WILLOUGHBY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4590
Country	:	US
Telephone Number	:	212-201-1252
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AZLAN TARIQ
Credential	:
Telephone Number	:	312-709-7238

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	12/03/2025

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Directions to “GREAT HEALTH MEDICAL IOWA PC ” Practice Location

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