Provider Demographics
NPI:1407963879
Name:IFTIKHAR, TARIQ BIN (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:BIN
Last Name:IFTIKHAR
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 1:6641 WEST OGDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3756
Mailing Address - Country:US
Mailing Address - Phone:708-484-9480
Mailing Address - Fax:708-484-9482
Practice Address - Street 1:6641 WEST OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3756
Practice Address - Country:US
Practice Address - Phone:708-484-9480
Practice Address - Fax:708-484-9482
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047917207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047917Medicaid
IL2072539OtherCIGNA
IL01633335OtherBCBS
IL050564332OtherHUMANA
ILAS62001780001OtherCIGNA
IL006895400OtherFEDERAL BLACK LUNG PROGRA
ILP00064487OtherRAILROAD MEDICARE
IL1343149OtherFIRST HEALTHNETWORK
IL154664OtherUNITEDHALTHCARE
IL202841400OtherACS/OWCP
IL3181386OtherAETNA
ILC43546Medicare UPIN
IL2072539OtherCIGNA