Provider Demographics
NPI:1861440190
Name:RATNANI, IQBAL M (MD)
Entity Type:Individual
Prefix:
First Name:IQBAL
Middle Name:M
Last Name:RATNANI
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 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7531207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01254114OtherMEDICARE RR
TX180322303Medicaid
TX180322302Medicaid
TX180322304Medicaid
TX8W4770OtherBLUE CROSS BLUE SHIELD
TX616192200OtherUS DEPT OF LABOR
TXP01030504OtherRR MEDICARE
TX8DY835OtherBLUE CROSS BLUE SHIELD
TXP01254114OtherMEDICARE RR
TXP01254114OtherMEDICARE RR
TX8DY835OtherBLUE CROSS BLUE SHIELD
TX616192200OtherUS DEPT OF LABOR
TX8W4770OtherBLUE CROSS BLUE SHIELD