Provider Demographics
NPI:1164601282
Name:JAVID IQBAL
Entity Type:Organization
Organization Name:JAVID IQBAL
Other - Org Name:ODESSA NEUROLOGY CLINIC AND EMG LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVAID
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-282-9881
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61130-0189
Mailing Address - Country:US
Mailing Address - Phone:815-282-9881
Mailing Address - Fax:815-282-9891
Practice Address - Street 1:1752 WINDSOR RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4280
Practice Address - Country:US
Practice Address - Phone:815-282-9881
Practice Address - Fax:815-282-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB29748Medicare UPIN
IL208102Medicare PIN