Provider Demographics
NPI:1003063959
Name:HAQUE, MONEERA NUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MONEERA
Middle Name:NUR
Last Name:HAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2393
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-2393
Mailing Address - Country:US
Mailing Address - Phone:312-469-0842
Mailing Address - Fax:
Practice Address - Street 1:125 E MAXWELL ST STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2678
Practice Address - Country:US
Practice Address - Phone:859-323-3231
Practice Address - Fax:859-257-9461
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055437207RC0000X
GA069323207RC0000X
NE31383207RC0000X
KYC0126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00372820Medicaid
GA003132396AMedicaid