MEDICARE: IQBAL A. CHOUDHRY, MD, INC.

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

General Provider Information

NPI Number	:	1790917003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IQBAL A. CHOUDHRY, MD, INC.

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 AVE NW
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	:	PRESIDENT
Name	:	IQBAL A CHOUDHRY
Credential	:	MD
Telephone Number	:	330-492-7827

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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