Provider Demographics
NPI:1174534473
Name:IQBAL, SHAHID (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4904
Mailing Address - Country:US
Mailing Address - Phone:813-876-0502
Mailing Address - Fax:813-872-6503
Practice Address - Street 1:5516 HANLEY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4904
Practice Address - Country:US
Practice Address - Phone:813-876-0502
Practice Address - Fax:813-872-6503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80570207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104722300Medicaid
FLH44072Medicare UPIN
FL260580500Medicaid