Basic Information
| Provider Information | |||||||||
| NPI: | 1932831609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALIQ | ||||||||
| FirstName: | IKRAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 731 PENN AVE APT 613 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152223426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122980908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 E NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123594971 | ||||||||
| FaxNumber: | 4123594490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT225405 | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.