Provider Demographics
NPI:1639261696
Name:NASIR, IQBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:IQBAL
Middle Name:
Last Name:NASIR
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 1:18161 W 13 MILE RD
Mailing Address - Street 2:SUITE D4
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-901-1111
Mailing Address - Fax:248-901-4444
Practice Address - Street 1:18161 W 13 MILE RD
Practice Address - Street 2:SUITE D4
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-901-1111
Practice Address - Fax:248-901-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039377207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1706324172OtherBCBS
MI412147084OtherTAX ID
MI1706324172OtherBCBS