Provider Demographics
NPI:1578515896
Name:IQBAL, MUHAMMAD RAGHIB (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:RAGHIB
Last Name:IQBAL
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 1:50 ALESSANDRO PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-657-0863
Mailing Address - Fax:626-639-6075
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 140
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-657-0863
Practice Address - Fax:626-639-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4444207R00000X
CAA94608207R00000X, 207RN0300X
NMRS2012-0789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235781Medicare PIN