Provider Demographics
NPI:1013052570
Name:IQBAL, ATIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ATIYA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:F
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:PO BOX 96221
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0127
Mailing Address - Country:US
Mailing Address - Phone:817-424-3366
Mailing Address - Fax:817-424-3426
Practice Address - Street 1:7151 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8029
Practice Address - Country:US
Practice Address - Phone:817-416-1931
Practice Address - Fax:817-488-8527
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD148OtherBCBS
TX8AD148OtherBCBS
G35246Medicare UPIN