Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01067972A | IN |
N | 207RH0003X | Hematology & Oncology | 22311 | WV |
N | 207RX0202X | Medical Oncology | 22311 | WV |
NPI | 1164477097 |
---|---|
Provider Name | Nadeem Ikhlaque |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46237-8601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2667412 | (05) | OH |
3810005631 | (05) | WV |
I54737 | (02) | |
P00373379 | RAILROAD MEDICARE (01) | WV |