Provider Demographics
NPI:1295765550
Name:QURESHI, IKRAM ULHAQ (MD)
Entity type:Individual
Prefix:DR
First Name:IKRAM
Middle Name:ULHAQ
Last Name:QURESHI
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 1:812 S WEEKS ST
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-3047
Mailing Address - Country:US
Mailing Address - Phone:850-547-4771
Mailing Address - Fax:850-547-3171
Practice Address - Street 1:812 S WEEKS ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-3047
Practice Address - Country:US
Practice Address - Phone:850-547-4771
Practice Address - Fax:850-547-3171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
592768062OtherTAX ID
FL039448300Medicaid
FL103877Medicare Oscar/Certification
592768062OtherTAX ID
FL039448300Medicaid