Provider Demographics
NPI:1457091803
Name:IQBAL, MIR SAJID
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:SAJID
Last Name:IQBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 DUNSTEN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2613
Mailing Address - Country:US
Mailing Address - Phone:773-392-0965
Mailing Address - Fax:
Practice Address - Street 1:606 DUNSTEN CIR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2613
Practice Address - Country:US
Practice Address - Phone:773-392-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver