Provider Demographics
NPI:1902009780
Name:IQBAL, MOHAMMED S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:S
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3306 WENDOVER CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3248
Mailing Address - Country:US
Mailing Address - Phone:469-757-1600
Mailing Address - Fax:469-519-0202
Practice Address - Street 1:2700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5899
Practice Address - Country:US
Practice Address - Phone:469-757-1600
Practice Address - Fax:469-519-0202
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3007207R00000X, 208000000X, 207RH0002X
IL036.123976208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF68911Medicare UPIN