Provider Demographics
NPI:1780655548
Name:IQBAL, VASEEM (MD)
Entity Type:Individual
Prefix:
First Name:VASEEM
Middle Name:
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 1:3695 GREEN RD
Mailing Address - Street 2:UNIT 22778
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:216-255-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG882892085R0202X, 2085P0229X
ARN-74282085P0229X, 2085R0202X
CODR.00486622085P0229X
WI523432085P0229X
KY414382085P0229X
DEC100089072085P0229X
NY1817552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200930130OtherHEALTHY INDIANA PLAN
MD200930130OtherMD WISE
AR114583001Medicaid
IN200930130Medicaid
KY000000545192OtherANTHEM
KY000023028ZOtherHUMANA
NY01548847Medicaid
KY50017557OtherPASSPORT
KY7100024950OtherKENTUCKY MEDICAID
KY50017557OtherPASSPORT
NYE16744Medicare UPIN
NYDD2073Medicare PIN
AR114583001Medicaid
AR52187Medicare PIN
NYRB1063Medicare PIN
NYDD3963Medicare PIN