Basic Information
| Provider Information | |||||||||
| NPI: | 1982054482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IQBAL | ||||||||
| FirstName: | ASIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58144 GRATIOT AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867495197 | ||||||||
| FaxNumber: | 5867495560 | ||||||||
| Practice Location | |||||||||
| Address1: | 58144 GRATIOT AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867495197 | ||||||||
| FaxNumber: | 5867495560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2016 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301109605 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 4301109605 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.