Provider Demographics
NPI:1609897396
Name:HAQUE, IKRAM UL (MD)
Entity Type:Individual
Prefix:DR
First Name:IKRAM
Middle Name:UL
Last Name:HAQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IKRAM
Other - Middle Name:UL
Other - Last Name:HAQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 3.228
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-5650
Mailing Address - Fax:713-500-0588
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:HP 9137
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-2238
Practice Address - Fax:713-704-3546
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL 425832080P0203X
FLME847322080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201562002OtherCSHCN
TX8BZ673OtherBCBSTX
FL264277800Medicaid
TX201562001Medicaid
TX8BZ673OtherBCBSTX
FLH63922Medicare UPIN
FL13197ZMedicare PIN