Provider Demographics
NPI:1376542035
Name:IFTIKHAR, FARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15777 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2385
Mailing Address - Country:US
Mailing Address - Phone:734-324-7800
Mailing Address - Fax:734-324-7801
Practice Address - Street 1:15777 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2385
Practice Address - Country:US
Practice Address - Phone:734-324-7800
Practice Address - Fax:734-324-7801
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4113737Medicaid
MI4899542Medicaid
MIP00477490OtherRAILROAD MEDICARE
MI4725187Medicaid
MI4932914Medicaid
MI4843690Medicaid
MI4603200Medicaid
MI4995682Medicaid
MI0P30940002Medicare PIN
MI0P29200002Medicare PIN
MIP00477490OtherRAILROAD MEDICARE
MI0N90660001Medicare PIN
MI0P38660001Medicare PIN
MI4995682Medicaid
MI4843690Medicaid
MI4603200Medicaid
MI0M96680003Medicare PIN