Provider Demographics
NPI:1629282546
Name:IFTEKHAR, RIFFAT (MD)
Entity Type:Individual
Prefix:DR
First Name:RIFFAT
Middle Name:
Last Name:IFTEKHAR
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 1:4115 W VISTARIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-8955
Mailing Address - Country:US
Mailing Address - Phone:309-689-5419
Mailing Address - Fax:
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3105
Practice Address - Country:US
Practice Address - Phone:888-627-5673
Practice Address - Fax:309-683-5669
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.113738OtherSTATE MEDICAL LICENSE
MO2007011377OtherSTATE MEDICAL LICENSE