Provider Demographics
NPI:1235137340
Name:IQBAL, MOHAMMAD S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:S
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LAUREL ST
Mailing Address - Street 2:STE 1300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3034
Mailing Address - Country:US
Mailing Address - Phone:515-883-2650
Mailing Address - Fax:515-883-2653
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:STE 1300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-883-2650
Practice Address - Fax:515-883-2653
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-02-24
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IA19258208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23380OtherWELLMARK PROVIDER NUMBAR
IA2099515Medicaid
IAA01084Medicare UPIN
IA2099515Medicaid