Basic Information
| Provider Information | |||||||||
| NPI: | 1841398138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IQBAL | ||||||||
| FirstName: | ATIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CAMBRIDGE ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735296386 | ||||||||
| FaxNumber: | 7137986244 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 CAMBRIDGE ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137984321 | ||||||||
| FaxNumber: | 7137986244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | T2005014364 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208C00000X | ME111589 | FL | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | R9372 | TX | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 004360300 | 05 | FL | MEDICAID |