Provider Demographics
NPI:1770599938
Name:IFTIKHAR, SYEDA A (MD)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:A
Last Name:IFTIKHAR
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 1:1507 S FALCON DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4897
Mailing Address - Country:US
Mailing Address - Phone:224-567-8713
Mailing Address - Fax:224-444-4533
Practice Address - Street 1:1507 S FALCON DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4897
Practice Address - Country:US
Practice Address - Phone:224-567-8713
Practice Address - Fax:224-444-4533
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21284207R00000X
IL036102332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35503OtherBLUE CROSS BLUE SHIELD
ILDN4121OtherRAILROAD MEDICARE
NE110232141OtherRAILROAD MEDICARE
ILK51298OtherMEDICARE PTAN
IL036102332Medicaid
NE274517Medicare PIN
NE110232141OtherRAILROAD MEDICARE