Provider Demographics
NPI:1437103629
Name:ALTAFULLAH, IRFAN MOHAMMAD (MB, BS)
Entity Type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:MOHAMMAD
Last Name:ALTAFULLAH
Suffix:
Gender:M
Credentials:MB, BS
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Mailing Address - Street 1:4225 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4215
Mailing Address - Country:US
Mailing Address - Phone:763-588-0661
Mailing Address - Fax:763-287-2310
Practice Address - Street 1:4225 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4215
Practice Address - Country:US
Practice Address - Phone:763-588-0661
Practice Address - Fax:763-287-2310
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN316252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1437103629Medicaid
MN100277C029OtherUCARE
MN0265046OtherPREFERRED ONE
MN0522654OtherMEDICA
MN1D717ALOtherBCBS OF MN
WI31739300Medicaid
MN130006223OtherRAILROAD MEDICARE
MNHP12787OtherHEALTHPARTNERS
MN22781OtherAMERICA'S PPO