Provider Demographics
NPI:1497747182
Name:NEUROLOGICAL ASSOCIATES OF ST PAUL PA
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF ST PAUL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-221-9051
Mailing Address - Street 1:1650 BEAM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1147
Mailing Address - Country:US
Mailing Address - Phone:651-221-9051
Mailing Address - Fax:651-223-5220
Practice Address - Street 1:1650 BEAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1147
Practice Address - Country:US
Practice Address - Phone:651-221-9051
Practice Address - Fax:651-223-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN829210800Medicaid
MN829210800Medicaid
MNC01099Medicare ID - Type Unspecified