Provider Demographics
NPI:1922288943
Name:IQBAL A NASIR MD PC
Entity Type:Organization
Organization Name:IQBAL A NASIR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-479-8000
Mailing Address - Street 1:19727 ALLEN RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1188
Mailing Address - Country:US
Mailing Address - Phone:734-479-8000
Mailing Address - Fax:734-479-4812
Practice Address - Street 1:19727 ALLEN RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1188
Practice Address - Country:US
Practice Address - Phone:734-479-8000
Practice Address - Fax:734-479-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3310713Medicaid
MI0P03280Medicare PIN
MI3310713Medicaid