Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036143551 | IL |
NPI | 1013264035 |
---|---|
Provider Name | Mehr P Iqbal |
First Address | Chicago, IL 60674-0264 |
Second Address | Romeoville, IL 60446-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036143551 | STATE LICENSE (01) | IL |