Basic Information
Provider Information
NPI: 1265845747
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: IQBAL
FirstName: KHURSHID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1095 HIGHWAY 15 S
Address2:  
City: HUTCHINSON
State: MN
PostalCode: 553505000
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1095 HIGHWAY 15 S
Address2:  
City: HUTCHINSON
State: MN
PostalCode: 55350
CountryCode: US
TelephoneNumber: 3202345000
FaxNumber: 3204844683
Other Information
ProviderEnumerationDate: 06/03/2014
LastUpdateDate: 08/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X64017MNY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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