Provider Demographics
NPI:1508159740
Name:SHAHID ALI IQBAL MD PA
Entity Type:Organization
Organization Name:SHAHID ALI IQBAL MD PA
Other - Org Name:FLORIDA ALLERGY & ASTHMA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-838-0472
Mailing Address - Street 1:5516 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4904
Mailing Address - Country:US
Mailing Address - Phone:813-876-0502
Mailing Address - Fax:813-872-6503
Practice Address - Street 1:5516 HANLEY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4904
Practice Address - Country:US
Practice Address - Phone:813-876-0502
Practice Address - Fax:813-872-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0080570207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101817700Medicaid
FLH44072Medicare UPIN
FL35794ZMedicare PIN