Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 46762 | MN |
N | 208600000X | Surgeon | 46762 | MN |
Y | 2086S0120X | Pediatric Surgery | 2010010720 | MO |
NPI | 1578533675 |
---|---|
Provider Name | Corey William Iqbal |
First Address | Overland Park, KS 66215-2307 |
Second Address | Overland Park, KS 66215-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133487500 | (05) | MN |
35225700 | (05) | WI |
ENROLLED | (05) | IA |