Provider Demographics
NPI:1063650489
Name:IQBAL, INTIKHAB (MD)
Entity Type:Individual
Prefix:
First Name:INTIKHAB
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:739 IRVING AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1655
Mailing Address - Country:US
Mailing Address - Phone:315-234-4815
Mailing Address - Fax:315-234-4805
Practice Address - Street 1:739 IRVING AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1655
Practice Address - Country:US
Practice Address - Phone:315-234-4815
Practice Address - Fax:315-234-4805
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI52951207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine