Provider Demographics
NPI:1174838452
Name:AHMAD, NASIR IQBAL (MD)
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:IQBAL
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 19674
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9674
Mailing Address - Country:US
Mailing Address - Phone:217-545-7644
Mailing Address - Fax:217-585-6890
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-545-7644
Practice Address - Fax:217-585-6890
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-0584792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry