Provider Demographics
NPI:1477523439
Name:NASIR, IQBAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:IQBAL
Middle Name:A
Last Name:NASIR
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 1:19727 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1188
Mailing Address - Country:US
Mailing Address - Phone:734-479-8000
Mailing Address - Fax:734-479-4812
Practice Address - Street 1:19727 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1188
Practice Address - Country:US
Practice Address - Phone:734-479-8000
Practice Address - Fax:734-479-4812
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI058753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3310713Medicaid
MI0P03280Medicare PIN
MIF69621Medicare UPIN