Provider Demographics
NPI:1205854015
Name:HUSSAIN, IFTIKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:IFTIKHAR
Middle Name:
Last Name:HUSSAIN
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 1:7307 S YALE AVE
Mailing Address - Street 2:SUITE: 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7049
Mailing Address - Country:US
Mailing Address - Phone:918-392-4550
Mailing Address - Fax:918-392-4551
Practice Address - Street 1:7307 S YALE AVE
Practice Address - Street 2:SUITE: 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7049
Practice Address - Country:US
Practice Address - Phone:918-392-4550
Practice Address - Fax:918-392-4551
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109720207RA0201X
OK25321207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27099Medicare UPIN