MEDICARE: MR. IKRAM UL HAQ 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	207RI0200X	Infectious Disease Physician	ME0075189	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110230818	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47246	OTHER	FL	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861427288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IKRAM UL HAQ MD

Provider Business Mailing Address
First Line	:	PO BOX 1442
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-6242
Country	:	US
Telephone Number	:	850-913-9294
Fax Number	:	850-481-1820

Provider Business Practice Location Address
First Line	:	750 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2524
Country	:	US
Telephone Number	:	850-913-9294
Fax Number	:	850-481-1820

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/18/2015

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