Provider Demographics
NPI:1881977098
Name:HAQ, EHSAN UL (MD)
Entity type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:UL
Last Name:HAQ
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 1:9765 BUCKHORN DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1320
Mailing Address - Country:US
Mailing Address - Phone:312-330-3367
Mailing Address - Fax:
Practice Address - Street 1:2555 CREEKWOOD CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4056
Practice Address - Country:US
Practice Address - Phone:937-327-0552
Practice Address - Fax:937-327-0556
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036465207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine