Provider Demographics
NPI:1942739107
Name:IQBAL, QASIM ZAFAR (MD)
Entity Type:Individual
Prefix:MR
First Name:QASIM
Middle Name:ZAFAR
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-843-0000
Practice Address - Fax:317-968-1278
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2023-08-09
Deactivation Date:2018-01-11
Deactivation Code:
Reactivation Date:2018-01-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01089823A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264910407OtherMEDICARE PTAN
IN300076725Medicaid