Provider Demographics
NPI:1508896671
Name:BADER, IFTEKHAR (MD)
Entity Type:Individual
Prefix:
First Name:IFTEKHAR
Middle Name:
Last Name:BADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3803 SPRING ST
Mailing Address - Street 2:STE 600
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1660
Mailing Address - Country:US
Mailing Address - Phone:262-687-8312
Mailing Address - Fax:262-687-8318
Practice Address - Street 1:3803 SPRING ST
Practice Address - Street 2:STE 600
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1660
Practice Address - Country:US
Practice Address - Phone:262-687-8312
Practice Address - Fax:262-687-8318
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI32076207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI132568000Medicaid