Provider Demographics
NPI:1861427288
Name:HAQ, IKRAM UL (MD)
Entity type:Individual
Prefix:MR
First Name:IKRAM
Middle Name:UL
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6242
Mailing Address - Country:US
Mailing Address - Phone:850-913-9294
Mailing Address - Fax:850-481-1820
Practice Address - Street 1:750 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-913-9294
Practice Address - Fax:850-481-1820
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075189207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47246OtherBCBS OF FL
FL258243100Medicaid
FL110230818OtherMEDICARE RAILROAD
FL47246Medicare ID - Type Unspecified
FL258243100Medicaid