Provider Demographics
NPI:1578533675
Name:IQBAL, COREY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:WILLIAM
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD STE 520
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2307
Mailing Address - Country:US
Mailing Address - Phone:913-310-0482
Mailing Address - Fax:913-894-1330
Practice Address - Street 1:10550 QUIVIRA RD STE 520
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2307
Practice Address - Country:US
Practice Address - Phone:913-310-0482
Practice Address - Fax:913-894-1330
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46762208600000X
MO20100107202086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN133487500Medicaid
WI35225700Medicaid
IAENROLLEDMedicaid
IAENROLLEDMedicaid
WI35225700Medicaid
MN020002417Medicare PIN
MN020002050Medicare PIN