Provider Demographics
NPI:1407842396
Name:PANHWAR, ABDUL KHALIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:KHALIQUE
Last Name:PANHWAR
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 1:1720 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1869
Mailing Address - Country:US
Mailing Address - Phone:641-456-5000
Mailing Address - Fax:641-456-5049
Practice Address - Street 1:1720 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1869
Practice Address - Country:US
Practice Address - Phone:641-456-5000
Practice Address - Fax:641-456-5049
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5239574Medicaid
IAP00200232OtherRR MEDICARE
H78903Medicare UPIN
IA5239574Medicaid