Provider Demographics
NPI:1578014254
Name:IQBAL, ZIA
Entity Type:Individual
Prefix:MR
First Name:ZIA
Middle Name:
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 1:18118 CHESTERFIELD AIRPORT RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1124
Mailing Address - Country:US
Mailing Address - Phone:314-757-7244
Mailing Address - Fax:
Practice Address - Street 1:18118 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:SUITE N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1124
Practice Address - Country:US
Practice Address - Phone:314-757-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT149125004172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver