Provider Demographics
NPI:1184606022
Name:IFTIKHAR, SHAUKAT (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUKAT
Middle Name:
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:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-858-4512
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9454
Practice Address - Fax:812-858-4512
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000468207RG0100X
IN01071136A207RG0100X
SC21426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100283850Medicaid
IN20128480Medicaid
NC0191FOtherNCBC GROUP
SC214262Medicaid
SCPC1896Medicaid
NC137WOOtherBCBS NC
NC89137W0Medicaid
NCP00442382OtherRR MEDICARE
KY7100283850Medicaid
SCG50902Medicare UPIN
NC2025430Medicare ID - Type UnspecifiedNC MEDICARE INDIVIDUAL
SC214262Medicaid
NC2320029Medicare ID - Type UnspecifiedNC MEDICARE GROUP
NC0191FOtherNCBC GROUP